左内頸動脈瘤術後に超皮質性感覚失語を呈した前脈絡叢動脈閉塞症の1例

Anterior choroidal artery territory infarction with transcortical sensory aphasia after a neck clipping of left internal carotid artery aneurysms:a case report

I．はじめに

　内頸動脈瘤手術において，瘤の周辺部より分岐する小血管を温存することは重要である．前脈絡叢動脈は，この血管閉塞によってAbbie症候群^1）と呼ばれる特異な神経症状が出現することで知られてきたが，われわれは左内頸動脈瘤手術に際して前脈絡叢動脈の閉塞を生じ，従来からAbbie症候群を構成するとされてきた片麻痺・半身知覚障害・半盲の他に，超皮質性感覚性失語を呈した症例を経験した．そこで，文献的考察を加え，内頸動脈瘤手術時の前脈絡叢動脈温存の重要性を一層喚起すべく報告する．

Anterior choroidal artery (Ach A) syndrome is wide-ly known to be composed of a triad of hemiparesis, hemisensory loss and homonymous hemianopia. The authors report a case of Ach A-territory infarction after a direct operation for internal carotid artery aneurysms, which presented transcortical sensory aphasia in asso-ciation with the characteristic triad. The literature and several previously reported cases with dominant and nondominant cerebral hemisphere signs in Ach A in-farction are reviewed. The danger of Ach A occlusion and the importance of preserving it during aneurysm surgery are emphasized.