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Neurological Surgery No Shinkei Geka Volume 26, Issue 10 （October 1998）

Neurological Surgery 脳神経外科 26巻10号（1998年10月発行）

Japanese English

症例

Azygos anterior cerebral arteryを伴ったlarge distal anterior cerebral artery aneurysmの1例 Large Distal Anterior Cerebral Artery Aneurysm Associated with Azygos Anterior Cerebral Artery : case report 鈴木泰篤 ¹ , 川俣光 ¹ , 松本浩明 ² , 国井紀彦 ² , 松本清 ² Yasuhiro SUZUKI ¹ , Teru KAWAMATA ¹ , Hiroaki MATSUMOTO ² , Norihiko KUNII ² , Kiyoshi MATSUMOTO ² ¹千葉西総合病院脳神経外科 ²昭和大学医学部脳神経外科 ¹Department of Neurosurgery, Chiba-Nishi General Hospital ²Department of Neurosurgery, Faculty of Medicine, Showa University キーワード： distal anterior cerebral artery , giant aneurysm , azygos artery , subarachnoid hemorrhage , diagonistic dyspraxia Keyword: distal anterior cerebral artery , giant aneurysm , azygos artery , subarachnoid hemorrhage , diagonistic dyspraxia pp.935-941

発行日 1998年10月10日 Published Date 1998/10/10

DOI https://doi.org/10.11477/mf.1436901630

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Abstract 文献概要
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I．はじめに

　末梢性前大脳動脈瘤（distal anterior cerehral ar-tery aneurysm，以下DACAA）は全脳動脈瘤の5％前後を占めると言われ^9），azygos anterior cere-bral artery（以下azygos ACA）をはじめとする前大脳動脈の異常を伴うことが多い^1）．発生部位は脳梁膝部付近に多く，これより末梢部の脳梁周囲動脈や脳梁辺縁動脈には少ない^19）．また大型の動脈瘤の報告は少なく，そのほとんどが脳梁膝部付近に発生している．今回われわれはazygos ACAの終末部のsupracallosal portionに発生したlargeaneurysmの1症例を経験した．脳梁膝部より末梢に発生したlarge aneurysmやgiant aneurysmは稀と考えられたので，その発生機序および手術手技につき若干の考察を加えて報告する．

A 51-year-old woman presented with a distal anterior cerebral artery aneurysm (DACAA) manifestingas severe headache and monoparesis of the left lower limb. Computed tomography revealed subarachnoidhemorrhage in the interhemispheric fissure, bilateral sylvian fissures, and basal cistern, and a hematoma inthe supracallosal region. Angiography showed a large aneurysm (23×18mm) located on the distal end ofthe azygos anterior cerebral artery (azygos ACA) at the supracallosal portion. T2-weightecl magnetic reso-nance imaging demonstrated the hematoma as a mixed intensity mass, compressing the corpus callosumdownward, and the aneurysm as a flow void anterior to the hematoma. Unilateral frontoparietal arasagit-tal craniotomy was performed with a horse-shoe shaped incision. The aneurysm was clipped via thein-terhemispheric approach, and the hematoma was aspirated. Postoperative angiography showed disappe-arance of the aneurysm and intact azygos ACA. The patient was discharged with mild monoparesis, pares-thesia of the left lower limb and diagonistic dyspraxia.

DACAA almost always arises at or near the genu of the corpus callosum and is often associated withvascular anomaly. In the literature, 22 of 26 cases of large and giant DACAA were located at or near thegenu, but only 3 cases, including ours, in the supracallosal area. 11 cases were associated withazygosACA. Therefore, hemodynamic stress caused by vascular anomaly may be involved in the formation oflarge or giant DACAA in contrast with cases of normal DACAA.