頭蓋内巨大動脈瘤の3例

THREE CASES OF HUGE INTRACRANIAL ANEURYSM

I．はじめに

　頭蓋内動脈瘤は，通常くも膜下出血によつてその存在が明らかとなる。しかしながら，時には動脈瘤の破綻を伴なわずに徐々にその大きさを増し，占居性病変として種々の神経圧迫症状をもつて発症し，脳血管写によつて初めて巨大動脈瘤である事が判る場合もある。このような巨大動脈瘤について文献的にみると，現在まで50数例の報告^{1）2）3）6）9）10）11）12）14）15）16）17）19）21）22）24）}がみられるが，そのほとんどは内頸動脈瘤であつて，その他の部位に発生したものは比較的少ない。

　われわれもくも膜下出血の既往をもたず，神経学的検査の段階で脳腫瘍が疑われた症例に対し，脳血管撮影を行つた結果，はじめて巨大動脈瘤である事が判明した内頸動脈瘤の2例と脳底動脈瘤の1例を経験したので報告する。

Case 1 was a 50-year-old woman who complained of visual disturbances and visual field defects. She had bitemporal upper quadrantanopsia and admitted with suspect of a pituitary adenoma. Left carotid angiograms revealed a huge aneurysm measuring 3.1×3.0×3.3cm in intracranial portion of theinternal carotid artery.

Case 2 was a 58-year-old woman who complained of diplopia. She had right oculomotor paresis. The carotid angiograms showed a giant aneurysm arising from intracranial portion of the right internal carotid artery measuring 2.6×2.6×3.0cm.

These two cases were effectively treated by liga-tion of the carotid artery in the neck. Subsequent carotid angiograms suggested reduction of the size of the aneurysm in case 1, and right oculomotor paresis completely disappeared in case 2.

Case 3 was a 25-year-old man who complained of headache, diplopia, dysarthria and difficulty in walking. The posterior fossa tumor was suspected neurollogically, but vertebral angiograms demon-strated a giant aneurysm occurring from the basilar artery measuring 4.9x3.7x3.8cm. As signs of markedly increased intracranial pressure were noted, ventriculo-atrial shunt operation was carried out. However, he unfortunately died of a rupture of the aneurysm next morning.