10年以上の長期追跡し得たGiant Serpentine Aneurysmの1例

Giant Serpentine Aneurysm Followed up for more than 10 Years

I．はじめに

　いわゆるGiant Serpentine Aneurysm（GSA）は神経放射線学的または病理学的に，部分的な血栓化と，その中に曲がりくねったvascular channelをる巨大動脈瘤とされている．

　今回，われわれはくも膜下出血にて発症した内頸動脈から中大脳動脈に及ぶGSAに対し，浅側頸動脈—中大脳動脈吻合術と内頸動脈結紮術を行い，その後約10年間の追跡期間中に形態変化を認めたので，若干の文献的考察を加え報告する．

We report a case of a giant serpentine aneurysm (GSA) located at the left internal carotid artery (ICA) and middle cerebral artery (MCA) treated by ligation of the left ICA with superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The aneu-rysm form changed variously during the follow-up period. A 35-year-old man was admitted with severe headache and convulsion. CT scan demonstrated sub-arachnoid hemorrhage. Left carotid angiogram demon-strated a giant serpentine aneurysm. Ligation of the ICA with STA-MCA anastomosis was performed be-cause of the difficulty involved in clipping. Right caro-tid angiogram obtained 5 years later revealed dis-appearance of the tortuous vascular channel and a new aneurysmal shadow at the left carotid bifurcation. The size of the aneurysmal shadow increased gradually over 10 years. MRI and MR angiography which clearly de-mostrated the presence of the aneurysm and the vascu-lar channel simultaneously were considered useful methods for diagnosis of GSA. The authors reviewed previous reports of 19 cases and investigated the mechanism of GSA.