鞍外進展を示す下垂体腺腫を伴った前床突起下動脈瘤の1例

A Rare Case of Infrachnoid Aneurysm with Pituitary Adenoma Extending over the Extrasellar Space

I．はじめに

　下垂体腺腫と脳動脈瘤の合併例は，過去に多数の報告がされている^{2,3,6,9,10-12）}．しかし下垂体腺腫とトルコ鞍部動脈瘤の合併例に対し，腺腫を摘出し同時に動脈瘤のクリッピングを行い得たという報告は非常に稀である4）．

　今回，われわれは鞍外進展を示した下垂体腺腫と前床突起下動脈瘤に対し腺腫摘出後，cntralateralに動脈瘤のクリッピングを行いえたので，若干の文献的考察を加え報告する．

A 39 year-old female patient suffering from amenor-rhea over the course of the last 14 years was admitted to our hospital on Dec. 12, '89.

Computed Tomography revealed a relatively high-density mass extending over the suprasellar portion and the sphenoid sinus. Enlargement and destruction of the sells turcica was demonstrated clearly by the plain cra-niogram. Right carotid angiography demonstrated an open siphon and a medially pointing aneurysm on the right anterior siphon.

Two staged operations were performed. On Jan. 23, '90, a transsphenoidal operation was performed to re-move the part of the tumor invading the sphenoid sinus. Two weeks later, on Feb. 9, '90, a transcranial operation was carried out for extirpation of the residual adenoma and direct neck clipping of the aneurysm. The tumor was subtotally removed through a left fronto-lateral craniotomy. By drilling away the tuberculum sel-lae and the planum sphenoidal the aneurysm was com-pletely clipped via a contralateral approach.

The postoperative neurorachological examinations de-monstrated that the aneurysm was clipped successfully and the adenoma was extirpated almost totally.