多発未破裂動脈瘤の経過観察中に急速に増大し破裂した前交通動脈瘤の1例

A Case of a Ruptured Anterior Communicating Aneurysm which was Originally the Smallest of Several Unruptured Aneurysms

Ⅰ．はじめに

　未破裂脳動脈瘤の治療方針は，一定の見解は得られていない^12）．どのような動脈瘤を手術すべきであるか，もしくは保存的に経過観察するべきかの判断は非常に困難な問題である．われわれは多発未破裂動脈瘤の経過観察中に急速に増大し破裂した前交通動脈瘤の一例を経験したので，小動脈瘤の破裂危険性および未破裂脳動脈瘤の手術適応に関する文献的考察を加えて報告する．

A 64-year-old male suddenly developed headache and nausea. He had been pointed 3 years before out as having an unruptured basilar artery aneurysm and a right middle cerebral artery aneurysm. Computed tomography (CT) re-vealed diffuse subarachnoid hemorrhage in the basal cistern and bilateral Sylvian and interhemispheric fissures. He-matomas in the anterior horns of the lateral ventricles and third ventricle were also seen. Angiography revealed an anterior communicating artery aneurysm, which, retrospectively, had been recognized as a small dilatation of artery wall 3 years before.