Neurological Surgery 脳神経外科46巻9号

2018年09月発行

症例

鼻出血で発症した海綿静脈洞部内頚動脈解離性動脈瘤の1例

著者： 木野弘善¹ 鶴田和太郎² 伊藤嘉朗¹ 滝川知司¹ 椎貝真成³ 丸島愛樹¹ 中居康展⁴ 山本哲哉¹ 松村明¹

所属機関： ¹筑波大学医学医療系脳神経外科 ²虎の門病院脳神経血管内治療科 ³筑波メディカルセンター病院放射線科 ⁴筑波メディカルセンター病院脳神経外科

ページ範囲：P.789 - P.795

Ⅰ．緒　　言
　海綿静脈洞部内頚動脈瘤の発生頻度は脳動脈瘤全体の2%程度と稀である¹³⁾．症状としては，mass effectによる頭痛や眼痛，第Ⅱ，Ⅲ，Ⅳ，Ⅵ脳神経障害に伴う眼球運動障害や視機能障害，さらに破裂を来した場合の内頚動脈海綿静脈洞瘻，くも膜下出血，硬膜下血腫，鼻出血などさまざまな症候を呈する⁹⁾．破裂海綿静脈洞部内頚動脈瘤の発生機序については，特発性，外傷性，感染性，動脈硬化性のものが報告されており，なかでも外傷性のものが多い¹⁴⁾．非外傷性に鼻出血のみで発症する海綿静脈洞部内頚動脈瘤は極めて稀である¹²⁾．
　今回われわれは，頭部外傷や感染の既往がなく，鼻出血のみで発症し，治療に難渋した海綿静脈洞部内頚動脈瘤の1例を経験したので，文献的考察を加えて報告する．

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