Neurological Surgery 脳神経外科45巻2号

2017年02月発行

総説

発生・解剖・遺伝からみた脳血管病変

著者： 小宮山雅樹¹

所属機関： ¹大阪市立総合医療センター脳血管内治療科

ページ範囲：P.103 - P.115

Ⅰ．はじめに
　脳血管病変は，頚部血管を含めた脳血管の異常であり，種々の原因による正常な脳血管の解剖学的構築や生理的な状態からの逸脱と考えられる．脳動静脈奇形（arteriovenous malformation：AVM）を代表とする先天性疾患では，「生下時に病変がある＝生まれつき」，つまり，病変の形成は出生前であると考えがちである．この発想の裏には，「出生までにすべての血管の発生過程は終了し，その異常は出生時のまま成人まで維持される」という考えがある．しかし，原因遺伝子の変異に起因することが判明している疾患であっても，出生後に病変が形成されることも多く，出生を境に先天性疾患と後天性疾患を区別することは正しくなく，病因の理解を困難にする¹⁷⁾．
　本稿では，発生・解剖・遺伝学的視点から，受精，出生，成熟，老化という時系列の中で種々の脳血管病変を概観することを試みた．このような視点は，血管病変の病因・病態を考える上で重要であり，多くの示唆を与えてくれる．脳血管の発生や個々の疾患の記載は誌面の関係で十分ではなく，参考文献を参照してほしい．

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