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Neurological Surgery No Shinkei Geka Volume 20, Issue 10 （October 1992）

Neurological Surgery 脳神経外科 20巻10号（1992年10月発行）

Japanese English

症例

再発性紡錘状内頸動脈瘤の1例 Recurrent Fusiform Aneurysm of the Internal Carotid Artery; A Case Report 大野正弘 ¹ , 原田重徳 ¹ , 若林繁夫 ² , 永井肇 ² Masahiro OHNO ¹ , Shigenori HARADA ¹ , Shigeo WAKABAYASHI ² , Hajime NAGAI ² ¹公立尾陽病院脳神経外科 ²名古屋市立大学脳神経外科 ¹Division of Neurosurgery, Biyoh Public Hospital ²Department of Neurosurgery, Nagoya City University キーワード： Booster clip , Fusiform aneurysm , Internal carotid artery , Recurrent aneurysm Keyword: Booster clip , Fusiform aneurysm , Internal carotid artery , Recurrent aneurysm pp.1079-1083

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

DOI https://doi.org/10.11477/mf.1436900540

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Abstract 文献概要
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I．はじめに

　紡錘状脳動脈瘤は脳底動脈，内頸動脈，中大脳動脈に見られるが，動脈硬化がその主因と考えられている．又，その形状，主要な分岐血管との関係から直達手術の適応となることは稀で，なされてもwrapping等のある意味では非根治的な手術に留まることが多いとされる．

　内頸動脈—後交通動脈分岐部動脈瘤の手術の後，その近傍の内頸動脈に紡錘状動脈瘤（fusiform aneurysm）が発生した症例を経験し直達手術を行った．完全なclip—pingは行えなかったが，術後血管撮影，術後経過，ともにほぼ満足できる結果が得られた．興味ある症例と考え，neck clipping後に動脈瘤が再発する成因について若干の文献的考察を行い報告する．

A 61-year-old woman was referred to our department on February 12, 1991, due to a fusiform aneurysm of her left internal carotid artery (ICA). She had received aneurysm surgery twice in other hospitals in the past. The first operation, in June, 1980, was for an unruptured, symptomatic left internal carotid-posterior communicat-ing aneurysm and the aneurysm disappeared completely after the neck clipping procedure was carried out by one of the authors. In November, 1990, she suffered from subarachnoid hemorrhage with a hematoma in the left frontal lobe. A ruptured anterior communicating aneurysm was clipped in another hospital, where abnor-mal dilatation of the left ICA was pointed out. She was referred to our department after a ventricular peritoneal shunt operation.

Though the postoperative angiogram performed in 1980 had shown complete disappearance of the left IC-PC aneurysm, it was presumed that the fusiform aneurysm which she presented at our department was re-current because it existed in almost the same place as the aneurysm which had been clipped. It was also in con-tact with a clip applied in 1980. In accord with the pa-tient's desire to receive surgery, the fusiform aneurysm was operated on directly, and it was remarkably reduced in size by dome clipping. During a clip, a Sugita booster clip was useful for preventing a slip-out of the clip appli-ed on the aneurysmal dome. The patient was discharged about 20 days after the operation and returned to her usual life.

A recurrent fusiform aneurysm of the ICA arising af-ter the neck clipping of IC-PC aneurysm has rarely been encountered. Causes of the recurrence of aneurysm after the neck clipping procedure are also discussed.