血管内手術によって治療した多発性細菌性脳動脈瘤の1例

A Case of Multiple Cerebral Mycotic Aneurysms Treated with Endovascular Surgery

I．はじめに

　細菌性脳動脈瘤は，破裂細菌性脳動脈瘤ではもちろんのこと未破裂細菌性脳動脈瘤においてもその出血率が高いため^2,3），化学療法に反応しないものに対しては何らかの外科的処置の対象となりうる．一方，細菌性動脈瘤は，感染性心内膜炎という，重症の基礎疾患を背景に持つ例が大多数であるため^1,5,16,19），全身麻酔は危険性が高くなり，治療法に制限を受ける．従って，細菌性脳動脈瘤の治療法としては，全身状態に左右されないものが理想的である．

　今回，基礎疾患の感染性心内膜炎が活動期で，全身麻酔下の開頭術が困難であった小児破裂細菌性脳動脈瘤を血管内手術により治療し良好な結果を得たので，若干の文献的考察を加え報告する．

A case of multiple mycotic cerebral aneurysms suc-cessfully treated with endovascular surgery is reported. A nine-year-old boy who has suffered from hyper-trophic obstructive cardiomyopathy and active infec-tious endocarditis in the mitral valve developed sudden consciousness disturbance and convulsion. Computer-ized tomography revealed subarachnoid hemorrhage with subcortical hematoma in the left parietal lobe. Angiography demonstrated four aneurysms at the distal part of the middle cerebral artery on both sides. Since his physical status had been deteriorating, it was diffi-cult to undergo a usual surgical operation. Therefore, endovascular surgery was performed. The catheter was super-selectively advanced to the parent artery of the left posterior parietal artery aneurysm which seemed to be the hemorrhagic source, and the embolization wasperformed using platinum coils and liquid embolization material. Angiography after embolization showed that the aneurysms had been successfully occupied by the materials while the aneurysm of the right anterior parietal artery had not responded antibiotic therapy. Therefore the second embolization was carried out to the parent artery of the aneurysm of the right anterior parietal artery one month later. The patient had no neurological deficit after embolization and no aneurysms have been detected by the follow-up angio-gram after the second embolization. An endovascular approach might be an alternative useful treatment for cases in which the patient has deteriorated so much that it is considered difficult to perform open cra-niotomy under general anesthesia.