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Neurological Surgery No Shinkei Geka Volume 20, Issue 6 （June 1992）

Neurological Surgery 脳神経外科 20巻6号（1992年6月発行）

Japanese English

研究

後下小脳動脈末梢部動脈瘤—自験15例の検討 Peripheral Aneurysms of the Posterior Inferior Cerebellar artery—Analysis of 15 cases 安藤隆 ¹ , 伊藤毅 ¹ , 吉村紳一 ¹ , 白紙伸一 ¹ , 中島利彦 ¹ , 西村康明 ¹ , 坂井昇 ¹ , 山田弘 ¹ , 大熊晟夫 ² , 田辺祐介 ³ , 船越孝 ⁴ Takashi ANDOH ¹ , Takeshi ITOH ¹ , Shin-ichi YOSHIMURA ¹ , Shin-ichi SHIRAKAMI ¹ , Toshihiko NAKASHIMA ¹ , Yasuaki NISHIMURA ¹ , Noboru SAKAI ¹ , Hiromu YAMADA ¹ , Akio OHUMA ² , Yuhsuke TANABE ³ , Takashi FUNAKOSHI ⁴ ¹岐阜大学脳神経外科 ²県立岐阜病院脳神経外科 ³岐阜市民病院脳神経外科 ⁴総合大雄会病院脳神経外科 ¹Department of Neurosurgery, Gifu University School of Medicine ²Department of Neurosurgery, Gifu Prefectural Hospital ³Department of Neurosurgery, Gifu City Hospital ⁴Department of Neurosurgery, Daiyuhkai General Hospital キーワード： AVM , Peripheral aneurysm , Posterior inferior cerebellar artery Keyword: AVM , Peripheral aneurysm , Posterior inferior cerebellar artery pp.683-690

発行日 1992年6月10日 Published Date 1992/6/10

DOI https://doi.org/10.11477/mf.1436900478

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Abstract 文献概要
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I．はじめに

　後下小脳動脈瘤は比較的稀で全頭蓋内の脳動脈瘤の1％以下とされている．そのほとんどは椎骨動脈の後下小脳動脈分岐部に生じ末梢部の動脈瘤は極めて稀である．今回，われわれは過去8年間に後下小脳動脈末梢部動脈瘤を15例経験したので，その臨床症候，診断，治療などにつき検討を加えて報告する．

Peripheral aneurysms of the posterior inferior cere-bellar artery (PICA) are rare. The authors report 15 cases of peripheral PICA aneurysms. Twelve of theaneurysms were discovered after their rupture and two were discovered after rupture of concomitant AVM, and one was detected incidentally. As to the location of aneurysms, more than half of the aneurysms arose at the telovelotonsillar segment. One patient had 2 aneurysms on the same peripheral PICA, which were not obvious on preoperative angiography because the ruptured one was partially thrombosed. Another rare case with aneurysm located at the internal auditory meatus is also reported.

The findings of CT were characteristic, namely hemorrhage in the fourth ventricle without obvious hemorrhage in the basal cisterns, or only within the cerebellar vermian cistern. This phenomenon strongly suggested the possibility of rupture of peripheral PICA aneurysms. As to the surgical results, 10 patients (71%) of the 14 patients had a good recovery, and 1 patient (7%) with nonrupture aneurysm had a fair result due to pre-existing pontine hemorrhage. Three patients (21%) died. Rebleecling occurred in 3 patients, but cerebral vasospasm occurred in only 1 patient.

Consequently, as peripheral PICA aneurysms are likely to he missed, and rebleeding is an unfavorable factor, one should try to demonstrate aneurysms with angiography, by using various methods such as sub-traction or magnification.