脳梁無形成と脂肪腫を合併したazygos anterior cerebral artery aneurysmの1例

A CASE OF AGENESIS OF THE CORPUS CALLOSUM ACCOMPANIED WITH A RUPTURED AZYGOS ANTERIOR CEREBRAL ARTERY ANEURYSM AND A LIPOMA:A CASE REPORT

　抄録　症例は53歳，女性。意識障害にて発症し，CTscanにより，クモ膜下出血と診断された。同時に，側脳室体部の左右への離開および後角の拡大があり，脳梁無形成の所見も呈していた。引き続き施行された脳血管撮影により，azygos anterior cerebral arteryが認められ，その末梢に破裂脳動脈瘤が見つけられた。その後，脳動脈瘤根治手術が行なわれ，術中に偶然小指頭大の脂肪腫が発見された。文献的には，脳梁無形成と脂肪腫の合併例，azygos anterior cerebral arteryと脳動脈瘤の合併例はよく知られている。しかし，本症例のごとく，四者をすべて合併した症例の報告は，渉猟し得た限り見っからず，非常に稀な症例と思われる。本論文では，特に発生学的な面から文献的考察を加えた。

A 53-year-old woman suffered from sudden onset of severe headache on February 28 in 1982. She was admitted to our hospital soon after onset. On admission, she had a severe headache and nausea, and her consciousness was drowsy.

CT scan showed a marked subarachnoid hemor-rhage with intracerebral and intraventricular he-matoma, a separation of the lateral ventricles with enlargement of posterior horns, and deformity of anterior horn. By these findings, the patient was diagnosed as an agenesis of the corpus callosum with subarachnoid hemorrhage. Left carotid ar-teriogram revealed an azygos anterior cerebelar artery and an aneurysm at the terminal portion of this artery.

Surgery was performed on the 24th day after subarachnoid hemorrhage. Operative finding re-vealed a little finger's head-sized tumor was situa-ted over the right frontobasal artery. An azygos anterior cerebral artery aneurysm was clipped and tumor was removed. Pathological diagnosis of the tumor was a lipoma. Namely, she had an agenesis of the corpus callosum, an azygos anterior cerebral artery, an aneurysm and a lipoma.

There are some reports in which an agenesis of the corpus callosum is accompanied with a lipoma and an azygos anterior cerebral artery is accompanied with an aneurysm. But a case of agenesis of the corpus callosum with an azygos anterior cerebral artery was rarely reported.

So this rare case with these anomalies was reported and pathogenesis about the development of 4 anomalies was also discussed.