鞍結節部髄膜腫術後に生じた外傷性脳動脈瘤の2例

Trallmatic Intracranial Aneurysms after Removal of Tuberculum Sella Meningioma:Case report

I．はじめに

　脳動脈が腫瘍に巻き込まれた場合，動脈壁の脆弱化と手術による剥離操作のために外傷性脳動脈瘤（Trauma—tic Aneurysm，以下TA）を生じ，術後の重大な合併症を来す恐れがある．しかし，その托防法及び治療法は確立されたものが少ない．われわれは鞍結節部髄膜腫術後にTAの破裂による脳内出血を生じ，内頸動脈バルーン閉塞が有効であった症例を2例経験したので，ここに紹介し治療法の問題点を含めて考察する．

Two cases of traumatic aneurysms (TA) of the inter-nal carotid artery (IC) due to removal of tuberculum sellae meningioMa (TSM) are presented, and ideal treatment of those aneurysms is discussed.

The tumor, compressing the IC laterally, was re-moved Out without arterial injury in case 1. Though the patient's postoperative course was uneventful, frontal and intraventricular hemorrhage developed 2 months after the operation, and an IC dorsal aneurysm was de-tected. Preoperative angiograms showed no aneurysm, so it was considered to be a traumatic aneurysm clue to the surgical procedure. The aneurysm was clipped at once, but postoperative angiograms showed recurrence of the aneurysm. IC balloon occlusion was carried out as the Matas test was negative. In case 2, a small tear in the IC was inadvertently made during recurrent TSM removal, which was wrapped with muscle using fibrin glue. 2 weeks after the operation, frontal hemor-rhage developed. Angiograms revealed a small aneurysm of the IC, which was considered to be a traumatic aneurysm. IC balloon occlusion was per-formed as the Matas test was negative. These 2 pa-tients have had no episodes of rerupture after the IC balloon occlusion.

Tumors and main arteries are frequently adhesive, so arteries are easily injured during removal of mening-iomas. Muscle wrapping was not enough to prevent TA formation. Neck clipping was not appropriate for treat-ment of TA, but IC balloon occlusion was an effective and excellent therapy for TA of IC.