椎骨動脈環椎部型窓形成に起因する脊髄圧迫ならびに後頭神経痛に対し，神経血管減圧術が有効であった1例

Surgical Decompression for the C-1 and C-2 Sensory Roots and Upper Cervical Cord in a Case with Cervical Myelopathy and Occipital Neuralgia due to Bilateral Fenestration of Vertebral Artery: A case report

I．はじめに

　JannettaやGardnerの報告以来，脳神経の微小血管圧迫による機能的疾患が注目され，顔面痙攣や三叉神経痛に対するmicrovascular decompressionは確立された手術方法となったと言える．最近では，痙性斜頸に対する副神経減圧術の有効性も報告されており，今回，私共は同様の機序にて，後頭神経痛をきたしたと思われる椎骨動脈環椎部型窓形成に対し，窓形成動脈の転位を施行し良好な結果を得た症例を経験したので報告する．

A case of bilateral fenestration of the vertebral artery at the level of the atlas in a patient who had occipital neuralgia and cervical myelopathy is presented. MRI and vertebral angiogram demonstrated the fenestrated verte-bral artery compressing the upper cervical cord. Surgical decompression for the C-1 and C-2 sensory roots and the upper cervical cord was performed.

Fenestration of the vertebral artery is mostly of no cli-nical significance.

However, considering the pathway of the fenestrated vertebral artery, it is quite possible that the fenestrated vertebral artery might compress the neural structures, re-sulting in some clinical problems.Although occipital neuralgia may result from a variety of causes, this case was caused by the fenestrated vertebral artery compress-ing the C-1 and C-2 sensory roots.

The authors wish to emphasize that microsurgical vascular decompression may be the only effective treat-ment in such cases as well as in facial spasm and trigeminal neuralgia.