Neurological Surgery 脳神経外科43巻12号

2015年12月発行

症例

解離性後大脳動脈瘤に対してステント併用コイル塞栓術を施行した1例

著者： 春間純¹ 杉生憲志¹ 雪上直人² 佐々木達也¹ 服部靖彦² 小林和樹² 吉田秀行² 棟田耕二² 伊達勲¹

所属機関： ¹岡山大学大学院脳神経外科 ²津山中央病院脳神経外科

ページ範囲：P.1099 - P.1104

Ⅰ．はじめに
　後大脳動脈瘤（posterior cerebral artery aneurysm：PCAAN）は全脳動脈瘤の0.7〜3%と稀である⁵⁾．また，PCAANは前方循環系の動脈瘤と比べて解離性動脈瘤が多いとされているが，その多くはP2 segmentに発生し，P1 segmentの解離性動脈瘤の報告は少ない¹⁵⁾．この部位は解剖学的特性から治療方法や手技に関しても議論の分かれるところである¹⁵⁾．今回われわれは，破裂解離性PCAANに対し，亜急性期にステント併用コイル塞栓術を施行した1例を経験したので，文献的考察を加えて報告する．

参考文献

1) Brassel F, Rademaker J, Haupt C, Becker H：Intravascular stent placement for a fusiform aneurysm of the posterior cerebral artery：case report. Eur Radiol 11：1250-1253, 2001

2) Ciceri EF, Klucznik RP, Grossman RG, Rose JE, Mawad ME：Aneurysms of the posterior cerebral artery：classification and endovascular treatment. AJNR Am J Neuroradiol 22：27-34, 2001

3) Ferrante L, Acqui M, Trillo G, Lunardi P, Fortuna A：Aneurysms of the posterior cerebral artery：do they present specific characteristics? Acta Neurochir（Wien）138：840-852, 1996

4) Geremia G, Brack T, Brennecke L, Haklin M, Falter R：Occlusion of experimentally created fusiform aneurysms with porous metallic stents. AJNR Am J Neuroradiol 21：739-745, 2000

5) Hamada J, Morioka M, Yano S, Todaka T, Kai Y, Kuratsu J：Clinical features of aneurysms of the posterior cerebral artery：a 15-year experience with 21 cases. Neurosurgery 56：662-670；discussion 662-670, 2005

6) Huang Q, Liu J, Zhao R, Hong B, Xu Y, Zhao W, Yang P, Li W：The safety and efficacy of stenting in the treatment of complex posterior cerebral artery aneurysms：a seven-case report and literature review. Clin Neuroradiol 23：175-187, 2013

7) Lylyk P, Ferrario A, Pasbon B, Miranda C, Doroszuk G：Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102：235-241, 2005

8) Mitchell GM, McCann JJ, Rogers IW, Hickey MJ, Morrison WA, O'Brien BM：A morphological study of the long-term repair process in experimentally stretched but unruptured arteries and veins. Br J Plast Surg 49：34-40, 1996

9) Mizutani T, Miki Y, Kojima H, Suzuki H：Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45：253-259；discussion 259-260, 1999

10) 杉生憲志，徳永浩司，伊達　勲：破裂急性期椎骨動脈解離性動脈瘤に対する血管内治療．No Shinkei Geka 32：1229-1238, 2004

11) Sugiu K, Tokunaga K, Watanabe K, Sasahara W, Ono S, Tamiya T, Date I：Emergent endovascular treatment of ruptured vertebral artery dissecting aneurysms. Neuroradiology 47：158-164, 2005

12) Taylor RA, Callison RC, Martin CO, Hayakawa M, Chaloupka JC：Acutely ruptured intracranial saccular aneurysms treated with stent assisted coiling：complications and outcomes in 42 consecutive patients. J Neurointerv Surg 2：23-30, 2010

13) Tumialan LM, Zhang YJ, Cawley CM, Dion JE, Tong FC, Barrow DL：Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms：a cautionary report. J Neurosurg 108：1122-1129, 2008

14) van Rooij WJ, Sluzewski M, Beute GN：Endovascular treatment of posterior cerebral artery aneurysms. AJNR Am J Neuroradiol 27：300-305, 2006

15) Wang H, Du R, Stary J, Gkogkas C, Kim D, Day A, Frerichs K：Dissecting aneurysms of the posterior cerebral artery：current endovascular/surgical evaluation and treatment strategies. Neurosurgery 70：1581-1588；discussion 1588, 2012

16) Wang J, Sun Z, Bao J, Zhang B, Jiang Y, Lan W：Characteristics and endovascular treatment of aneurysms of posterior cerebral artery. Neurol India 59：6-11, 2011

17) Yavuz K, Geyik S, Pamuk AG, Koc O, Saatci I, Cekirge HS：Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms. J Neurosurg 107：49-55, 2007

18) Yeung TW, Lai V, Lau HY, Poon WL, Tan CB, Wong YC：Long-term outcome of endovascular reconstruction with the Pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 116：882-887, 2012

19) Zeal AA, Rhoton AL Jr：Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 48：534-559, 1978

20) Zenteno M, Modenesi Freitas JM, Aburto-Murrieta Y, Koppe G, Machado E, Lee A：Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms. Surg Neurol 66：603-610；discussion 610, 2006

21) Zhang J, Lv X, Jiang C, Li Y, Yang X, Wu Z：Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels. Neurol Res 32：119-122, 2010