もやもや病に生じた前脈絡叢動脈末梢の脳動脈瘤に対して選択的コイル塞栓術を行った1例

Selective Coil Embolization of a Distal Anterior Choroidal Artery Aneurysm Associated with Moyamoya Disease: A Case Report

Ⅰ．はじめに

　もやもや病は動脈瘤を5～15%程度に伴い^1,7,10)，破裂してしばしば頭蓋内出血の原因となり得る．そのなかでも前脈絡叢動脈末梢の動脈瘤は稀であり，脳室内出血の原因として重要である¹⁰⁾．前脈絡叢動脈はもやもや病において重要な側副血行路であり，その末梢の動脈瘤の治療には慎重な治療戦略が求められる．しかし，保存的加療，直達手術，血管内治療などさまざまな治療が報告され，親血管の温存などについて議論の余地がある^{2-6,8,11-18,20,22,23)}．

　今回われわれは，前脈絡叢動脈末梢の破裂脳動脈瘤に対してコイル塞栓術を行った症例を経験した．症例報告を行い，治療戦略について考察する．

　Intracranial hemorrhage in patients with moyamoya disease is often caused by rupture of the associated aneurysms. Of these aneurysms, distal anterior choroidal artery（AChoA）aneurysms are rare. In patients with moyamoya disease, the AChoA constitutes collateral vessels and the aneurysm requires careful treatment strategy. However, reported cases of distal AChoA aneurysms include various procedures including conservative therapy, direct surgery, and endovascular therapy. Herein, we report a case of coil embolization of a distal AChoA aneurysm associated with moyamoya disease and discuss the treatment strategy.

　A 39-year-old female presented with severe headache and subsequent deep coma. Computed tomography（CT）revealed thick intraventricular hemorrhage, and three-dimensional CT angiography revealed a right distal AChoA aneurysm. Bilateral ventricular drainage was performed and subsequent ventriculoperitoneal（VP）shunt was performed. The persisting distal AChoA aneurysm was coil embolized without any complication. Rebleeding did not occur during the 1-year follow-up period.

　Endovascular treatment is effective for distal AChoA aneurysms associated with moyamoya disease to preserve collateral circulation.