Neurological Surgery 脳神経外科43巻5号

2015年05月発行

症例

破裂巨大紡錘状前大脳動脈瘤に対しA3-A3 bypass併用下にproximal clippingを行った1例

著者： 尾崎沙耶¹ 宮崎始¹ 麓憲行¹ 尾上信二¹ 市川晴久¹ 福本真也¹ 田中英夫¹ 宇都宮裕² 中村寿² 河野兼久¹

所属機関： ¹愛媛県立中央病院脳卒中センター脳神経外科 ²十全総合病院脳神経外科

ページ範囲：P.435 - P.443

Ⅰ．はじめに
　多くの血管が絡む前交通動脈近傍の巨大脳動脈瘤は，頻度は低いものの治療困難な症例が多く，個々の症例に応じて治療方針を検討しなければならない．しかし，特に破裂例に関して治療方針や術後画像所見，高次脳機能を含む予後について述べた文献は少ない．今回，われわれは左前大脳動脈から発生し，前交通動脈を巻き込んだ破裂巨大紡錘状前大脳動脈瘤に対してA3-A3 bypass併用下にproximal clippingを行った症例を経験した．その治療戦略および術後経過について文献的考察を含めて報告する．

参考文献

1) Abla AA, Lawton MT：Anterior cerebral artery bypass for complex aneurysms：an experience with intracranial-intracranial reconstruction and review of bypass options. J Neurosurg 120：1364-1377, 2014

2) Chen PR, Abla AA, McDougall CG, Spetzler RF, Albuquerque FC：Surgical techniques for unclippable fusiform A2-anterior cerebral artery aneurysms and description of a frontopolar-to-A2 bypass. World Neurosurg 81：441. e9-441. e15, 2014

3) Crowell RM, Morawetz RB：The anterior communicating has significant branches. Stroke 8：272-273, 1977

4) Dengler J, Kato N, Vajkoczy P：The Y-shaped double-barrel bypass in the treatment of large and giant anterior communicating artery aneurysms. J Neurosurg 118：444-450, 2013

5) 藤田勝三，白國隆行，鈴木寿彦，増村道雄，朝田雅博，江原一雅，玉木紀彦，松本　悟：脳動脈瘤のneck clipping後に発生した穿通動脈閉塞症例の検討．脳卒中の外科19：624-630, 1991

6) Hernesniemi J, Dashti R, Lehecka M, Niemela M, Rinne J, Lehto H, Ronkainen A, Koivisto T, Jaaskelainen JE：Microneurosurgical management of anterior communicating artery aneurysms. Surgical Neurology 70：8-29, 2008

7) Hong JH, Choi BY, Chang CH, Kim SH, Jung YJ, Byun WM, Jang SH：Injuries of the cingulum and fornix after rupture of an anterior communicating artery aneurysm：a diffusion tensor tractography study. Neurosurgery 70：819-823, 2012

8) Inoue T, Tsutsumi K, Ohno H, Shinozaki M：Revascularization of the anterior cerebral artery with an A3-A3 anastomosis and a superficial temporal artery bypass using an A3-radial artery graft to trap a giant anterior communicating artery aneurysm：technical case report. Neurosurgery 57（1 Suppl）：E207, 2005

9) Kim K, Mizutani T, Mizutani N, Kobayashi S, Takizawa K, Kamiyama H, Murai Y, Teramoto A：Giant intracranial aneurysm of the anterior communicating artery treated by direct surgery using A3-A3 side-to-side anastomosis and A3-Ra graft-STA anastomosis. Acta Neurochir（Wien） 148：353-357, 2006

10) Kimura T, Nishimura K, Fukaya S, Morita A：Fusiform aneurysm of the anterior communicating artery treated by vascular reconstruction：case report. Neurosurgery 66：E1025-E1026, 2010

11) Kumral E, Evyapan D, Balkir K：Acute caudate vascular lesions. Stroke 30：100-108, 1999

12) Little JR, Louis PS, Weinstein M, Dohn DF：Giant fusiform aneurysm of the cerebral arteries. Stroke 12：183-188, 1981

13) Mabuchi S, Kamiyama H, Kobayashi N, Abe H：A3-A3 side-to-side anastomosis in the anterior communicating artery aneurysm surgery：report of four cases. Surg Neurol 44：122-127, 1995

14) Mugikura S, Kikuchi H, Fujii T, Murata T, Takase K, Mori E, Marinkovic S, Takahashi S：MR imaging of subcallosal artery infarct causing amnesia after surgery for anterior communicating artery aneurysm. AJNR Am J Neuroradiol 35：2293-2301, 2014

I-Iomazenil SPECTによる局在診断．日職災医誌60：199-205, 2012

16) Nakajima H, Kamiyama H, Nakamura T, Takizawa K, Ohata K：Direct surgical treatment of giant intracranial aneurysms on the anterior communicating artery or anterior cerebral artery. Neurol Med Chir（Tokyo） 53：153-156, 2013

17) Park ES, Ahn JS, Park JC, Kwon do H, Kwun BD, Kim CJ：STA-ACA bypass using the contralateral STA as an interposition graft for the treatment of complex ACA aneurysms：report of two cases and a review of the literature. Acta Neurochir（Wien）154：1447-1453, 2012

18) Quinones-Hinojosa A, Lawton MT：In situ bypass in the management of complex intracranial aneurysms：technique application in 13 patients. Neurosurgery 57（1 Suppl）：140-145, 2005

19) Sanai N, Zador Z, Lawton MT：Bypass surgery for complex brain aneurysms：an assessment of intracranial-intracranial bypass. Neurosurgery 65：670-683, 2009

20) 佐々木達也，佐藤園美，佐久間　潤，紺野　豊，佐藤正憲，鈴木恭一，松本正人，児玉南海雄：脳動脈瘤術後の穿通枝梗塞．脳卒中の外科30：101-106, 2002

21) Sekhar LN, Natarajan SK, Britz GW, Ghodke B：Microsurgical management of anterior communicating artery aneurysms. Neurosurgery 61（5 Suppl 2）：273-290, 2007

22) UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T：The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366：2474-2482, 2012

23) Yeo SS, Jang SH：Recovery of an injured fornix in a stroke patient. J Rehabil Med 45：1078-1080, 2013

24) Yokoh A, Ausman JI, Dujovny M, Diaz FG, Berman SK, Sanders J, Mirchandani HG：Anterior cerebral artery reconstruction. Neurosurgery 19：26-35, 1986