第3脳室経由で到達した高位脳底動脈瘤の1例

High Position Basilar Top Aneurysm treated via Third Ventricle

　I．はじめに

　脳底動脈末端部動脈瘤の手術は，通常Drake^4）のsub—temporal approachもしくはYasargil^14）のpterionalapproachにて行われている．しかし，脳底動脈末端部が高い位置にある場合や，megadolichobasilar anomaly^2）を伴ったこの部の動脈瘤の症例では，いずれのapproachにても手術は困難もしくは到達不可能な場合がある．

　今回われわれは，megadolichobasilar anomalyを伴った脳底動脈末端部動脈瘤の症例において，すでに第3脳室底部が一部破壊されていたことから，両側前頭葉間から接近し，終板，第3脳室底を経由して動脈瘤を処置した1例を経験したので報告する．

There are two major approaches to basilar top aneurysm: one is subtemporal by Drake, another is pterional by Yasargil. In either approach, however, it is hazardous and difficult to approach basilar top aneurysm with megadolichobasilar anomaly because strong retraction of brain, nerve and vessel is re-quired.

A successful case of ruptured basilar top aneurysm with megadolichohasilar anomaly treated directly through the third ventricle is reported.

A 62-year-old woman was admitted with con-sciousness disturbance.