幼児の頭蓋内動脈瘤—自験例，および手術例を中心とした文献的考察

INTRACRANIAL ANEURYSM IN AN INFANT: REPORT OF A CASE AND REVIEW OF THE LITERATURE

はじめに

　幼児の頭蓋内動脈瘤はまれである。今までに報告された5歳以下の幼児の21症例のうち，脳血管撮影で診断がつき，手術が行なわれた症例は6例あつた。臨床症状が詳しく記載されていた5例は手術危険率の高い状態（Huntらの分類^7）の第IVあるいは第V度）であったが，手術成績はきわめて良好であったことを知った。幼児の頭蓋内動脈瘤は手術成績がきわめて良好であるので，診断は重要である。

　著者らは1歳10カ月で発症した右中大脳動脈の主分岐部の動脈瘤の1例を報告し，5歳以下の幼児の頭蓋内動脈瘤について手術成績を中心に文献的考察を加える。

A case is reported of a boy who suddenly started to cry and became opisthotonic followed by gene-ralized tonic convulsion at the age of 22 months. He had nausea and vomiting frequently. Nuchal rigidity was noted. A lumber spinal tap yielded grossly bloody cerebrospinal fluid. At times gener-al convulsion occurred and the patient developed a left hemiparesis. Right carotid angiography dis-closed an aneurysm, 2.1 × 1.1 cm in diameter, located on the region of the main middle cerebral branch-ing on the right. Right fronto-temporal cranio-tomy was carried out. The aneurysm was treated by encasement in the plastic (EDH-Adhesive). Postoperatively the patient recovered gradually. He is developing normally with no objective evi-dence of residual neurological abnormality.

The literature on intracranial aneurysms in infants and children under the age of five years is reviewed. It is found that clinical and patho-logical features greatly differ from those in aduts.

Six patients were diagnosed by cerebral angiogr-le nt and operated upon : Surgical results were excel-aphy in 5 cases, all of which were in the state of poor surgical risk (Grade IV or V by Hunt's classi-fication) at the time of surgery, while one became hemiparetic and had seizures. Therefore, it should be pointed out that the surgical results in infants and young children in the state of poor surgical risk at the time of surgery are found to be far better than those in a comparable group of adults.