経時的変化が確認できた解離性中大脳動脈瘤の1例
頭蓋内解離性動脈瘤は椎骨脳底動脈系に多く, 内頸動脈系に少ないと報告されている. 紡錘状動脈瘤, 解離性動脈瘤という用語は病態, 形態学的所見が同じ土俵で議論され概念が曖昧である. 近年, Mizutani11)は, giant fusiform aneurysm, megadolichobasilar aneurysm, giant serpentine aneurysmと呼ばれている脳動脈瘤も, 脳動脈解離を原因として巨大動脈瘤になるという概念を提唱している. 今回われわれは経時的観察により中大脳動脈狭窄症より紡錘状動脈瘤への変化が確認できた症例を経験した. 紡錘状動脈瘤の成因を考えるうえ...
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| Published in | 脳卒中の外科 Vol. 32; no. 5; pp. 370 - 375 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
30.09.2004
日本脳卒中の外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.32.370 |
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| Abstract | 頭蓋内解離性動脈瘤は椎骨脳底動脈系に多く, 内頸動脈系に少ないと報告されている. 紡錘状動脈瘤, 解離性動脈瘤という用語は病態, 形態学的所見が同じ土俵で議論され概念が曖昧である. 近年, Mizutani11)は, giant fusiform aneurysm, megadolichobasilar aneurysm, giant serpentine aneurysmと呼ばれている脳動脈瘤も, 脳動脈解離を原因として巨大動脈瘤になるという概念を提唱している. 今回われわれは経時的観察により中大脳動脈狭窄症より紡錘状動脈瘤への変化が確認できた症例を経験した. 紡錘状動脈瘤の成因を考えるうえで示唆に富む症例であり報告する. 症例 症例：54歳, 女性. 既往歴：高血圧, 高脂血症. 家族歴：特記すべきことなし. 現病歴：1993年1月28日, 頭重感, 右片麻痺が出現し当科に入院した. 脳梗塞, 左中大脳動脈狭窄と診断し, 保存的加療を行った. 右片麻痺は数日で改善し, 以後神経脱落症状なく外来通院していた. 頭部MRA上, 同部位に紡錘状の動脈瘤が疑われたため, 2002年10月29日入院となった. |
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| AbstractList | 頭蓋内解離性動脈瘤は椎骨脳底動脈系に多く, 内頸動脈系に少ないと報告されている. 紡錘状動脈瘤, 解離性動脈瘤という用語は病態, 形態学的所見が同じ土俵で議論され概念が曖昧である. 近年, Mizutaniは, giant fusiform aneurysm, megadolichobasilar aneurysm, giant serpentine aneurysmと呼ばれている脳動脈瘤も, 脳動脈解離を原因として巨大動脈瘤になるという概念を提唱している. 今回われわれは経時的観察により中大脳動脈狭窄症より紡錘状動脈瘤への変化が確認できた症例を経験した. 紡錘状動脈瘤の成因を考えるうえで示唆に富む症例であり報告する. 症例 症例:54歳, 女性. 既往歴:高血圧, 高脂血症. 家族歴:特記すべきことなし. 現病歴:1993年1月28日, 頭重感, 右片麻痺が出現し当科に入院した. 脳梗塞, 左中大脳動脈狭窄と診断し, 保存的加療を行った. 右片麻痺は数日で改善し, 以後神経脱落症状なく外来通院していた. 頭部MRA上, 同部位に紡錘状の動脈瘤が疑われたため, 2002年10月29日入院となった.The term "fusiform aneurysm" often causes confusion because it, is sometimes wrongly used synonymously with the term "dissecting aneurysm." We report a rare case of dissecting aneurysm in the left middle cerebral artery (MCA). A 45-year-old woman was admitted to our hospital with right hemiparesis on January 28, 1993. CT showed an infarct in the territory of the perforating branch of the M1 segment. Carotid angiogram showed a linear stenosis in the M1 distal portion. The patient was treated conservatively, and remained neurologically stable for 9 years following initial presentation, but serial magnetic resonance angiography (MRA) revealed growth of the aneurysm. Carotid angiogram showed a fusiform aneurysm of the M1-2 portion. The patient, underwent surgery by left pterional approach on November 11, 2002. The wall was yellow, firm, and arteriosclerotic. Finally, it was coated with Bemsheet soaked in Biobond. The postoperative course was uneventful. We suggest that in the present case of fusiform aneurysm, the pathogenesis is dissection. Careful interpretation of serial angiograms and magnetic resonance images will be necessary for a long time because the disease may progress. If the aneurysmal size increases, surgery must be evaluated. 頭蓋内解離性動脈瘤は椎骨脳底動脈系に多く, 内頸動脈系に少ないと報告されている. 紡錘状動脈瘤, 解離性動脈瘤という用語は病態, 形態学的所見が同じ土俵で議論され概念が曖昧である. 近年, Mizutani11)は, giant fusiform aneurysm, megadolichobasilar aneurysm, giant serpentine aneurysmと呼ばれている脳動脈瘤も, 脳動脈解離を原因として巨大動脈瘤になるという概念を提唱している. 今回われわれは経時的観察により中大脳動脈狭窄症より紡錘状動脈瘤への変化が確認できた症例を経験した. 紡錘状動脈瘤の成因を考えるうえで示唆に富む症例であり報告する. 症例 症例：54歳, 女性. 既往歴：高血圧, 高脂血症. 家族歴：特記すべきことなし. 現病歴：1993年1月28日, 頭重感, 右片麻痺が出現し当科に入院した. 脳梗塞, 左中大脳動脈狭窄と診断し, 保存的加療を行った. 右片麻痺は数日で改善し, 以後神経脱落症状なく外来通院していた. 頭部MRA上, 同部位に紡錘状の動脈瘤が疑われたため, 2002年10月29日入院となった. |
| Author | 神山, 悠男 多田, 恵曜 関貫, 聖二 |
| Author_FL | TADA Yoshiteru KOUYAMA Yukio KANNUKI Seiji |
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| DocumentTitleAlternate | Dissecting Aneurysm of the Middle Cerebral Artery Growing During Long-term Follow-up : A Case Report |
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| References | 1) 阿美古征生，岡村知實，黒川 泰，ほか：非外傷性中大脳動脈解離性動脈瘤の診断と治療．脳神経外科 27: 743-749, 1999 6) Isono M, Abe T, Goda M, et al: Middle cerebral artery dissecting aneurysm causing intracerebral hemorrhage 4 years after the non-hemorrhagic onset: A case report. Surg Neurol 57: 346-350, 2002 12) Mizutani T: A fatal, chronically growing basilar artery: a new of dissecting aneurysm. J Neurosurg 84: 962-971, 1996 21) Yasui T, Komiyama M, Nishikawa M, et al: Fusiform vertebral artery aneurysm as a cause of dissecting aneurysms. J Neurosurg 91: 139-144, 1999 10) Kitani R, Itougi T, Noda Y, et al: Dissecting aneurysms of the anterior circle of Willis arteries. J Neurosurg 67: 296-300, 1987 7) Iwamuro Y, Jito J, Shirahata M, et al: Transient ischemic attack due to dissection of the middle cerebral artery. Neurol Med Chir (Tokyo) 41: 399-401, 2001 4) Borzone M, Altomonte M, Baldini M, et al: Ginant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature. Acta Neurochir (Wien) 125: 184-187, 1993 3) Anson JA, Lawton MT, Spetzler RF: Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84: 185-193, 1996 5) Hayes WT, Bernhardt H, Young JM: Fusiform arteriosclerotic aneurysms of the basilar artery: Five cases including two ruptures. Vasc Surg 1: 171-178, 1967 8) 上山博康，野村三起夫，阿部 弘，ほか：頭蓋内解離性動脈瘤の診断．脳卒中の外科 18: 50-56, 1990 16) Nagahiro S, Hamada J, Sakamoto Y, et al: Follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation by using gadolinium-enhanced magnetic resonance imaging. J Neurosurg 87: 385-390, 1997 9) Kitanaka C, Tanaka J, Kuwahara M, et al: Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80: 667-674, 1994 2) 秋山義典，伊藤 毅，熊井潤一郎，ほか：非出血発症椎骨動脈解離性動脈瘤の経時的血管撮影による検討．脳神経外科 24: 443-449, 1996 20) Tsutsumi M, Kawano T, Kawaguchi T, et al: Dissecting aneurysm of the vertebral artery causing subarachnoid hemorrhage after non-hemorrhagic infartion. Neurol Med Chir (Tokyo) 40: 628-631, 2000 18) 仁村太郎，奥 達也，成田徳雄，ほか：中大脳動脈解離性動脈瘤の1例．脳神経外科 28: 61-65, 2000 11) Kurino M, Yoshioka S, Ushio Y: Spontaneous dissecting aneurysms of anterior and middle cerebral artery associated with brain infarction. A case report and review of the literature. Surg Neurol 57: 427-437, 2002 19) Sakamoto S, Ikawa F, Kawamoto H, et al: Acute surgery for ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery. Case report. Neurol Med Chir (Tokyo) 43: 188-191, 2003 13) Mizutani T: Middle cerebral artery dissecting aneurysm with persistent patent pseudolumen. J Neurosurg 84: 267-268, 1996 14) Mizutani T: Subarachnoid hemorrhage associated with angiographic “stenosis” or “occlusive” lesions in the carotid circulation. Surg Neurol 49: 495-504, 1998 15) 中島 進，野村貞宏，友清 誠，ほか：くも膜下出血で発症し，脳血管撮影にて完全閉塞の所見を呈したM2部解離性中大脳動脈瘤の1例．脳神経外科 30: 541-545, 2002 17) Niikawa S, Yamada J, Sumi Y, et al: Dissecting aneurysm of the middle cerebral artery manifesting as subarachnoid hemorrhage and hemorrhagic infarctions. Case report. Neurol Med Chir (Tokyo) 42: 62-66, 2002 |
| References_xml | – reference: 3) Anson JA, Lawton MT, Spetzler RF: Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84: 185-193, 1996 – reference: 8) 上山博康，野村三起夫，阿部 弘，ほか：頭蓋内解離性動脈瘤の診断．脳卒中の外科 18: 50-56, 1990 – reference: 15) 中島 進，野村貞宏，友清 誠，ほか：くも膜下出血で発症し，脳血管撮影にて完全閉塞の所見を呈したM2部解離性中大脳動脈瘤の1例．脳神経外科 30: 541-545, 2002 – reference: 6) Isono M, Abe T, Goda M, et al: Middle cerebral artery dissecting aneurysm causing intracerebral hemorrhage 4 years after the non-hemorrhagic onset: A case report. Surg Neurol 57: 346-350, 2002 – reference: 9) Kitanaka C, Tanaka J, Kuwahara M, et al: Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80: 667-674, 1994 – reference: 12) Mizutani T: A fatal, chronically growing basilar artery: a new of dissecting aneurysm. J Neurosurg 84: 962-971, 1996 – reference: 19) Sakamoto S, Ikawa F, Kawamoto H, et al: Acute surgery for ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery. Case report. Neurol Med Chir (Tokyo) 43: 188-191, 2003 – reference: 13) Mizutani T: Middle cerebral artery dissecting aneurysm with persistent patent pseudolumen. J Neurosurg 84: 267-268, 1996 – reference: 21) Yasui T, Komiyama M, Nishikawa M, et al: Fusiform vertebral artery aneurysm as a cause of dissecting aneurysms. J Neurosurg 91: 139-144, 1999 – reference: 5) Hayes WT, Bernhardt H, Young JM: Fusiform arteriosclerotic aneurysms of the basilar artery: Five cases including two ruptures. Vasc Surg 1: 171-178, 1967 – reference: 16) Nagahiro S, Hamada J, Sakamoto Y, et al: Follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation by using gadolinium-enhanced magnetic resonance imaging. J Neurosurg 87: 385-390, 1997 – reference: 4) Borzone M, Altomonte M, Baldini M, et al: Ginant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature. Acta Neurochir (Wien) 125: 184-187, 1993 – reference: 10) Kitani R, Itougi T, Noda Y, et al: Dissecting aneurysms of the anterior circle of Willis arteries. J Neurosurg 67: 296-300, 1987 – reference: 14) Mizutani T: Subarachnoid hemorrhage associated with angiographic “stenosis” or “occlusive” lesions in the carotid circulation. Surg Neurol 49: 495-504, 1998 – reference: 18) 仁村太郎，奥 達也，成田徳雄，ほか：中大脳動脈解離性動脈瘤の1例．脳神経外科 28: 61-65, 2000 – reference: 20) Tsutsumi M, Kawano T, Kawaguchi T, et al: Dissecting aneurysm of the vertebral artery causing subarachnoid hemorrhage after non-hemorrhagic infartion. Neurol Med Chir (Tokyo) 40: 628-631, 2000 – reference: 17) Niikawa S, Yamada J, Sumi Y, et al: Dissecting aneurysm of the middle cerebral artery manifesting as subarachnoid hemorrhage and hemorrhagic infarctions. Case report. Neurol Med Chir (Tokyo) 42: 62-66, 2002 – reference: 7) Iwamuro Y, Jito J, Shirahata M, et al: Transient ischemic attack due to dissection of the middle cerebral artery. Neurol Med Chir (Tokyo) 41: 399-401, 2001 – reference: 11) Kurino M, Yoshioka S, Ushio Y: Spontaneous dissecting aneurysms of anterior and middle cerebral artery associated with brain infarction. A case report and review of the literature. Surg Neurol 57: 427-437, 2002 – reference: 2) 秋山義典，伊藤 毅，熊井潤一郎，ほか：非出血発症椎骨動脈解離性動脈瘤の経時的血管撮影による検討．脳神経外科 24: 443-449, 1996 – reference: 1) 阿美古征生，岡村知實，黒川 泰，ほか：非外傷性中大脳動脈解離性動脈瘤の診断と治療．脳神経外科 27: 743-749, 1999 |
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| Snippet | 頭蓋内解離性動脈瘤は椎骨脳底動脈系に多く, 内頸動脈系に少ないと報告されている. 紡錘状動脈瘤, 解離性動脈瘤という用語は病態, 形態学的所見が同じ土俵で議論され概念が曖昧である. 近年, Mizutani11)は, giant fusiform aneurysm, megadolichobasilar... 頭蓋内解離性動脈瘤は椎骨脳底動脈系に多く, 内頸動脈系に少ないと報告されている. 紡錘状動脈瘤, 解離性動脈瘤という用語は病態, 形態学的所見が同じ土俵で議論され概念が曖昧である. 近年, Mizutaniは, giant fusiform aneurysm, megadolichobasilar aneurysm,... |
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| SubjectTerms | coating dissecting aneurysm fusiform aneurysm middle cerebral artery |
| Title | 経時的変化が確認できた解離性中大脳動脈瘤の1例 |
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