胎児型後交通動脈から生じた真性後交通動脈瘤破裂症例に対する外科的治療 Surgical Treatment for a Ruptured True Posterior Communicating Artery Aneurysm Arising on the Fetal-Type Posterior Communicating Artery : Two Case Reports and Review of the Literature

    • 中野 良昭 NAKANO Yoshiteru
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan
    • 齋藤 健 SAITO Takeshi
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan
    • 山本 淳考 [他] YAMAMOTO Junkoh
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan
    • 高橋 麻由 TAKAHASHI Mayu
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan

    • 秋葉 大輔 AKIBA Daisuke
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan
    • 北川 雄大 KITAGAWA Takehiro
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan
    • 宮岡 亮 MIYAOKA Ryo
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan
    • 植田 邦裕 UETA Kunihiro
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan

    • 黒川 暢 KUROKAWA Toru
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan
    • 西澤 茂 NISHIZAWA Shigeru
    • 産業医科大学医学部脳神経外科学教室 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Japan

Abstract

後交通動脈自体から生じる真性脳動脈瘤は少ないことが知られている.特徴を有する真性後交通動脈瘤の破裂を生じた2症例を文献的な考察を加え報告する.43歳男性,胎児型後交通動脈から生じた真性後交通動脈瘤破裂によるくも膜下出血を生じ,脳動脈瘤クリピング術を施行した.手術では,脳動脈瘤が側頭葉に埋没していたため,脳動脈瘤を露出させるには脳の牽引が必要であった.脳の牽引を行った際に,脳動脈瘤の術中破裂を生じたため,仮のクリッピングを行い,出血をコントロールし完全な脳動脈瘤クリッピングを行った.71歳女性,意識障害が出現し,同様にくも膜下出血を生じ,脳動脈瘤クリッピング術を施行した.脳動脈瘤の発生,増大,破裂には血行力学的な要因が関与すると考えられており,特に真性後交通動脈瘤の発生には重要な要因となる.文献によると,真性後交通動脈瘤は胎児型後交通動脈からの発生が81.8%とほとんどであった.つまり,胎児型後交通動脈による血行力学的な要因が脳動脈瘤の発生に強く関与していると考えられる.また,解剖学的な位置より脳動脈瘤は側頭葉内に埋没していることが多く,脳動脈瘤クリッピング術の際には脳の牽引が必要となり,術中に脳動脈瘤の破裂を生じる危険性が高くなる.真性後交通動脈瘤を手術する際には,牽引時の術中破裂を特に注意し,出血をコントロールする対応策を備えておくべきである.

Only a small number of aneurysms arising on the posterior communicating artery itself (true Pcom aneurysm) have been reported. We report two cases of ruptured true Pcom aneurysms with some characteristic features of true Pcom aneurysm. A 43 year old man suffering from subarachnoid hemorrhage (SAH) had an aneurysm arising on the fetal-type Pcom artery itself, and underwent surgery for clipping. Most of the aneurysm was buried in the temporal lobe, so retraction of the temporal lobe was mandatory. During the retraction, premature rupture was encountered. After tentative dome clipping and the control of bleeding, complete clipping was achieved. Another patient, a 71 year old woman presenting with consciousness disturbance due to SAH, had an aneurysm on the fetal-type Pcom artery itself, and underwent surgery for clipping. It has been generally considered that hemodynamic factor plays an important role in the formation, the growth, and the rupture of the cerebral aneurysm. This factor is especially significant in true Pcom aneurysm formation and rupture. According to the literature, a combination of fetal type Pcom and formation of the true Pcom aneurysm has been reported in most cases (81.8%). Most of the aneurysm can be buried in the temporal lobe, and the retraction of the temporal lobe during the dissection of the neck would be necessary, which causes premature rupture of the true Pcom aneurysm. In the surgery for a true Pcom aneurysm, we should be aware of possible premature rupture when temporal lobe retraction is necessary.

Journal

Journal of UOEH   [List of Volumes]

Journal of UOEH 33(4), 303-312, 2011-12-01  [Table of Contents]

The UOEH Association of Health Sciences

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Codes

  • NII Article ID (NAID) :
    110008798966
  • NII NACSIS-CAT ID (NCID) :
    AN0009832X
  • Text Lang :
    ENG
  • ISSN :
    0387821X
  • NDL Article ID :
    023443135
  • NDL Call No. :
    Z19-1000
  • Databases :
    NDL  NII-ELS 

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