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Neurological Surgery No Shinkei Geka Volume 28, Issue 3 （March 2000）

Neurological Surgery 脳神経外科 28巻3号（2000年3月発行）

Japanese English

症例

動脈解離を疑い血管内治療を行った前下小脳動脈末梢部動脈瘤の1例 An Arterial Dissection of the Distal Anterior Inferior Cerebellar Artery Treated by Endovascular Therapy 斎藤敦志 ^1,4 , 江面正幸 ¹ , 高橋明 ² , 吉本高志 ³ Atsushi SAITO ^1,4 , Masayuki EZURA ¹ , Akira TAKAHASHI ² , Takashi YOSHIMOTO ³ ¹広南病院血管内脳神経外科 ²東北大学大学院神経病態制御学分野 ³東北大学大学院神経外科学分野 ⁴石巻赤十字病院脳神経外科 ¹Department of Neuroendovascular Therapy, Kohnan Hospital ²Department of Neuroendovascular Therapy, Tohoku University School of Medicine ³Department of Neurosurgery, Tohoku University School of Medicine ⁴Department of Neurosurgery, Ishinomaki Red Cross Hospital キーワード： dissection , subarachnoid hemorrhage , posterior circulation , anterior inferior cerebellar artery , endovascular treatment Keyword: dissection , subarachnoid hemorrhage , posterior circulation , anterior inferior cerebellar artery , endovascular treatment pp.269-274

発行日 2000年3月10日 Published Date 2000/3/10

DOI https://doi.org/10.11477/mf.1436901864

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Abstract 文献概要
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I．はじめに

　診断技術の進歩に伴い，頭蓋内動脈解離の病態が明らかにされつつある．しかし，末梢領域の動脈解離は，まだ報告例も少なく病態が十分には解明されておらず，また治療法も確立されていない．今回，われわれはくも膜下出血にて発症した前下小脳動脈末梢動脈瘤に対し，動脈解離を強く疑い，血管内治療を行った．若干の考察を加えて報告する．

A rare case of a dissection of the distal anterior inferior cerebellar artery (AICA) is presented. A 68-year-old woman with sudden onset of headache was admitted. Computed tomographic (CT) scan demon-strated no subarachnoid hemorrhage. Seven days later, CT scan revealed subarachnoid and intraventricular hemorrhage. Left vertebral angiogram showed an aneurysmal dilatation on the distal AICA with a diagno-sis of suspected arterial dissection. At that time, we chose delayed craniotomy to observe the lesion direct-ly. However, rebleeding causing aggravation of the patient's systemic condition delayed radical tratment.19 days after rebleeding, by a superselective angiogram, endovascular treatment was selected to prevent further bleeding. The lesion was diagnosed as dissection of the AICA. The parent AICA was occluded with a Guglielmi detachable coil and fibered platinium coils.

Dissection of the distal portion of the cerebellar artery is rare. Only six cases have been reported in the posterior inferior cerebellar artery (PICA) and two cases in the superior cerebellar artery (SCA). Howev-er, to our knowledge, no such case has been reported in the AICA. Ruptured dissection of distal PICA or SCA is reported to require early treatment to prevent further bleeding. Ruptured dissection of the distal AICA also requires early treatment. Two cases of distal dissection of PICA and SCA successfully treated by endovascular treatment are reported. Endovascular treatment has some benefits in that it does not al-ways require general anesthesia and in that it can follow diagnostic angiography. On the other hand, saccular aneurysms of the distal AICA do not always require early treatment, such as removal of hemato-ma because of low incidence of vasospasm. So, to decide the treatment, precise diagnosis of the dissection is very important.