対側開頭にてクリップし得た“真の”後交通動脈動脈瘤の1例

Clipping of Aneurysm Arising from the Posterior Communicating Artery Itself by Contralateral Craniotomy:A case report

I．はじめに

　後交通動脈自体より生じた動脈瘤の頻度は全脳動脈瘤の0-3.7％であり^{7,10,11,16,23,25,26）}，比較的稀である．この動脈瘤に対しては通常患側の前頭側頭開頭にてクリッピング術が行われている．今回われわれは多発脳動脈瘤の症例において，前頭側頭開頭により，対側の“真の”後交通動脈動脈瘤をクリッピングし得たので報告する．

A case of aneurysm arising from the posterior com-municating artery itself clipped by contralateral fron-totemporal craniotomy (pterional approach) is pre-sented.

A 65-year-old female developed sudden severe headache and chest pain in January of 1993. Neurolo-gical examination on admission revealed consciousness disturbance such as stupor and nuchal stiffness. CT-scan showed marked subarachnoid hemorrhage. She also suffered from acute myocardial ischemia and car-diac failure. Cerebral angiograms after recovery from cardiac dysfunction demonstrated three saccular aneu-rysms arising from the dilated right posterior communi-cating artery itself, the junction of the left internal caro-tid artery and the posterior communicating artery, and the bifurcation of the left middle cerebral artery. The left IC-PC junction aneurysm was thought to be rup-tured because of its size and contour, so left fron-totemporal craniotomy was undertaken. By the left pterional approach, successful clipping of all three aneurysms involving the one arising from the contra-lateral posterior communicating artery was achieved. The aneurysm at the posterior communicating artery it-self was found to arise from the non-branching site and to project inferiorly, thus the successful clipping through the prechiasmal cistern could be performed without compromising any small perforating arteries.