海綿静脈洞症候群（cavernous sinus syndrome）を主徴とした巨大内頸動脈瘤の1例

A CASE OF A LARGE INTERNAL CAROTID ANEURYSM MANIFESTING "CAVERNOUS SINUS SYNDROME"

I．はじめに

　1872年Bartholow^1）が初めて頭蓋内動脈瘤を報告して以来，これに関する症例報告ならびに研究は枚挙にいとまがない。特に脳血管撮影術の普及に伴い，その発見率は急激に増加した。頭蓋内動脈瘤の大きさに関しては，本邦の報告例で最大径3cmを越えるものは非常に少なく，レ線上確認1例，手術確認1例，剖検確認2例である^2）〜5）。最近私どもは，いわゆる海綿静脈洞症候群を呈する1例に脳血管写を行ない，最大径4.5cmの巨大な内頸動脈の動脈瘤を証明し，trappingによつて良好な結果を得たので報告する。私どもの症例は，内頸動脈部の動脈瘤に関する報告例のなかでは大きさの点で最大のものである。

This is to report a 54-year-old Japanese housewife who was admitted to the Department of Neurology, Kyushu University, on May 9, 1966 with the chief complaints of visual loss of the left eye, squint, droop-ing of the left upper eyelid, neuralgic pains on the left face, and occasional headaches. These symptoms appeared insidiously about 7 months prior to the ad-mission, and have been slowly progressive. The neuro-logical examination on admission disclosed a slight to moderate paresis of the left 2nd, 3rd, 4th, 5th (1st and 2nd branches only), 6th and 7th cranial nerves. Routine laboratory examinations were within normal limits, including lumbar puncture and electroencephalo-gram. Skull X-ray series revealed an erosion of the left anterior and posterior clinoid processes. The optic foramen view showed characteristically an erosion of the lateral bony wall of the left optic canal.The left carotid angiography revealed a large, 4.5×4.0×4.0cm sized aneurysm in the intracranial, infraclinoid portion of the left internal carotid artery. Since the cross-filling angiography with the left carotid compre-ssion disclosed that the aneurysm was located proxi-mal to the anterior-middle bifurcation, a ligation of the cervical portion of the left internal carotid artery in combination with clipping of the efferent artery was performed, followed by satisfactory results with-out any complication.

The aneurysm in this case was the largest among the internal carotid aneurysms previously reported in Japan.

We discussed "cavernous sinus syndrome". The sym-ptoms, seen in our case, were different from the so-called "cavernous sinus syndrome" in that our case also had an impairment of the taste sense unilaterally on the left.