血管内手術にて処置し得たmycotic ICA petrous portion aneurysmの1例

A case of mycotic ICA petrous portion aneurysm treated with endovascular surgery

I．はじめに

　内頸動脈（ICA）錐体部に生じる動脈瘤は比較的稀な疾患であるが，錐体骨内に発生するため治療の困難な疾患の1つである．この部位の動脈瘤に対しては直達手術が行われることもあるが，一般的にはICAの結紮術，トラッピングが行われる．しかし，ICAの結紮術やトラッピング法は患側内頸動脈を遮断することになり，脳虚血の危険性が常につきまとうため理想的な治療法とは言えなかった．

　今回，われわれは大量の耳出血にて発症した細菌性ICA錐体部動脈瘤に対し血管内手術を行い，親動脈の順行性の血流を保ちつつ動脈瘤のみを塞栓し得た1例を経験したので報告する．

A case is reported of mycotic aneurysm at the pet-rous portion of the internal carotid artery (ICA) treated with an endovascular procedure. A sixty-seven-year-old male who had suffered from chronic otitis mediabilaterally for the last five years showed a sudden onset of massive left otorrhagia. Cerebral angiogram at the eighth day of otorrhagia disclosed a big aneurysm at the petrous portion of the left ICA. The aneurysm was round in shape but its wall was irregular. The angio-gram also showed that a stenotic finding of the left ICA just at the proximal portion of the anurysm and the neck of the aneurysm was not broad. Bone window computed tomography showed a destroyed petrous bone around the left ICA. The results of the Matas test and the Allcock test told us that left ICA occlusion should not be selected as a treatment. We decided that endovascular surgery could be applied as the treatment of this pathology. An endovascular procedure was per-formed for this pathology one month after the otor-rhagia. The aneurysm was successfully embolized using platinum coils beside a part of the neck without occlu-sion of the parent artery. The patient's postoperative course was not eventful. We concluded that endovascu-lar surgery might be the first choice for the treatment of an ICA petrous portion mycotic aneurysm.