脳血管非分岐部に生じた脳動脈瘤 : 血豆状脳動脈瘤. 4例の報告 Aneurysm at Nonbranching Sites of the Internal Carotid Artery : Blood Blister-like Aneurysm. Report of 4 cases

著者は,過去7年間に103例の脳動脈瘤(117脳動脈瘤)を経験し(100例は直達手術,3例は血管内手術を施行した),うち4例(3例が破裂,1例が未破裂)が血豆状脳動脈瘤であった.これらはすべて内頸動脈の非血管分岐部に生じた.すべて経シルビウス到達法にて手術を行い,wrappingとclippingの組み合わせによる脳動脈瘤処理を3例に行い,1例ではclippingのみを行った,結果としてはclippingのみを行った破裂症例にて術後に再出血を認めた.wrappingとclipping行った破裂症例(2例)では,術後出血は認めていない.1例の未破裂例では著変なく経過している.これらの4症例について詳しく報告し,血豆状脳動脈瘤手術に関しての問題点に関し文献的考察を加えて報告する.

I encountered 4 cases of blood blister-like aneurysm (3 ruptured and 1 unruptured) during the past 7 years. The unruptured one was accompanied by a ruptured internal carotid-ophthalmic aneurysm. These aneurysms constitute 3.4% of the total of 117 aneurysms managed by open or endovascular surgery during the same period. In these 4 cases, the lesion arose at the nonbranching site on internal carotid artery. The 4 aneurysms were operated upon via a transsylvian approach. A combination of both wrapping and clipping was done in 3 cases, and for the remaining 1 (ruptured) clipping only. The aneurysm managed by clipping only suffered postoperative massive bleeding because of an inappropriate obliteration of the proximal aneurysmal neck. The other 2 ruptured aneurysms that underwent both wrapping and clipping did not suffer any bleeding postoperatively, and 1 patient with an unruptured aneurysm has been in good condition. I detail the course of these 4 cases and problems concerning management for blood blister-like aneurysm.