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Neurological Surgery No Shinkei Geka Volume 23, Issue 11 （November 1995）

Neurological Surgery 脳神経外科 23巻11号（1995年11月発行）

Japanese English

症例

外傷性中硬膜動脈偽性動脈瘤の1例 Posttraumatic Pseudoaneurysm of the Middle Meningeal Artery:a case report 木村輝雄 ^1,2 , 佐古和廣 ² , 佐藤正夫 ¹ , 中井啓文 ¹ , 米増祐吉 ² , 竹内恵理保 ³ , 石倉浩 ³ Teruo KIMURA ^1,2 , Kazuhiro SAKO ² , Masao SATOH ¹ , Hirofumi NAKAI ¹ , Yuukichi YONEMASU ² , Eriho TAKEUCHI ³ , Hiroshi ISHIKURA ³ ¹名寄市立総合病院脳神経外科 ²旭川医科大学脳神経外科 ³北海道大学病理学第一講座 ¹Department of Neurosurgery, Nayoro City Hospital ²Department of Neurosurgery, Asahikawa Medical College ³Department of Clinical Pathology, Hokkaido University School of Medicine キーワード： Head injury , Skull fracture , Acute epidural hematoma , Middle meningeal artery , Pseudoaneurysm Keyword: Head injury , Skull fracture , Acute epidural hematoma , Middle meningeal artery , Pseudoaneurysm pp.1021-1025

発行日 1995年11月10日 Published Date 1995/11/10

DOI https://doi.org/10.11477/mf.1436901116

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Abstract 文献概要
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I．はじめに

　頭部外傷による偽性動脈瘤は比較的稀な疾患であるが，その合併は外傷直後または遅発性に頭蓋内血腫をもたらす点で重要である．外傷性偽性動脈瘤の報告の多くは内頸動脈系であるが，今回われわれは外傷によると思われる外傷性中硬膜動脈の偽性動脈瘤の1例を経験したので本例の発生機序について文献的考察を加え報告する．

An epidural hematoma associated with posttraumatic pseudoaneurysm of the middle meningeal artery is a very rare clinical entity. Only 31 such cases have been reported in the literature.

A 54-year-old man was admitted with lethargy and right hemiparesis. A skull X-ray film revealed a linear fracture in the left parietal and temporal bone, extend-ing to the base of the skull. A brain CT scan disclosed an acute epidural hematoma over the left cerebral hemisphere, contusional hematoma in the right frontal lobe and thalamus, and subarachnoid hemorrhage in the left Sylvian fissure. During an emergency cra-niotomy a large epidural hematoma was evacuated and external decompression was performed. Angiography, which was performed about one month after the head injury, revealed an aneurysm of the middle meningeal artery. The aneurysm was removed to avoid delayed rupture at the time of cranioplasty. Histological diagno-sis was pseudoaneurysm.

We discussed the pathogenesis of a pseudoaneurysm of the meningeal artery and the necessity to pay atten-tion to the presence of a pseudoaneurysm when an ac-tive bleeding point is not observed during surgery of the epidural hematoma.