Neurological Surgery 脳神経外科48巻5号

2020年05月発行

症例

前下小脳動脈圧迫による外転神経麻痺に対して微小血管減圧術が奏効した1例

著者： 手賀丈太¹ 小林広昌¹ 神﨑由起¹ 福本博順¹ 松本德彦¹ 藤原史明¹ 竹本光一郎¹ 安部洋¹ 井上亨¹

所属機関： ¹福岡大学医学部脳神経外科

ページ範囲：P.429 - P.434

Ⅰ．はじめに
　微小血管減圧術（microvascular decompression：MVD）は，顔面痙攣や三叉神経痛などに対して効果的であるが，外転神経麻痺における報告は少なく，診断や治療方針に苦慮することがある．今回，前下小脳動脈（anterior inferior cerebellar artery：AICA）圧迫による外転神経麻痺に，右椎骨動脈（vertebral artery：VA）—後下小脳動脈（posterior inferior cerebellar artery：PICA）動脈瘤を合併した症例を経験し，外転神経麻痺に対してAICA transpositionによるMVD，VA-PICA動脈瘤に対して右後頭動脈（occipital artery：OA）-PICA bypass＋VA近位部とPICA起始部のclippingを一期的に施行し，外転神経麻痺の著明な改善を認めた．診断と治療方法に関して文献的考察を加えて報告する．

参考文献

1) Choudhari KA：Isolated abducent nerve palsy after microvascular decompression for trigeminal neuralgia：case report. Neurosugery 57：E1317, 2005

2) De Ridder D, Menovsky T：Neurovascular compression of the abducent nerve causing abducent palsy treated by microvascular decompression. Case report. J Neurosurg 107：1231-1234, 2007

3) Goldenberg-Cohen N, Miller NR：Noninvasive neuroimaging of basilar artery dolichoectasia in a patient with an isolated abducens nerve paresis. Am J Ophthalmol 137：365-367, 2004

4) Hitotsumatsu T, Matsushima T, Inoue T：Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia：three surgical approach variations：technical note. Neurosurgery 53：1436-1441；discussion 1442-1443, 2003

5) Kato H, Nakajima M, Ohnaka Y, Ishihara K, Kawamura M：Recurrent abducens nerve palsy associated with neurovascular compression. J Nuerol Sci 295：135-136, 2010

6) Narai H, Manabe Y, Deguchi K, Iwatsuki K, Sakai K, Abe K：Isolated abducens nerve palsy caused by vascular compression. Neurology 55：453-454, 2000

7) Nunta-Aree S, Patiwech K, Sitthinamsuwan B：Microvascular decompression for treatment of trigeminal neuralgia：factors that predict complete pain relief and study of efficacy and safety in older patients. World Neurosurg 110：e979-e988, 2018

8) 大橋元一郎，入江是明，谷　諭，小川武希，阿部俊昭，畑　雄一：脳底動脈の圧迫による外転神経麻痺の1例．脳神経53：69-72, 2001

9) Ohtsuka K, Sone A, Igarashi Y, Akiba H, Sakata M：Vascular compressive abducens nerve palsy disclosed by magnetic resonance imaging. Am J Ophthalmol 122：416-419, 1996

10) Sandvand KA, Ringstad G, Kerty E：Periodic abducens nerve palsy in adults caused by neurovascular compression. J Neurol Neurosurg Psychiatry 79：100-102, 2008

11) Smoker WRK, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S：High-resolution computed tomography of the basilar artery：2. Vertebrobasilr dolichoectasia：clinical-pathologic correlation and review. AJNR Am J Neuroradiol 7：61-72, 1986

12) Taniguchi A, Ii Y, Kobayashi H, Maeda M, Tomimoto H：Bilateral abducens nerve palsy by compression from bilateral anterior inferior cerebellar artery. J Neurol 258：2271-2273, 2011

13) Tsai TH, Demer JL：Nonaneurysmal cranial nerve compression as cause of neuropathic strabismus：evidence from high-resolution magnetic resonance imaging. Am J Ophthalmol 152：1067-1073. e2, 2011

14) Yamazaki T, Yamamoto T, Hatayama T, Zaboronok A, Ishikawa E, Akutsu H, Matsuda M, Kato N, Matsumura A：Abducent nerve palsy treated by microvascular decompression：a case report and review of the literature. Acta Neurochir（Wien）157：1801-1805, 2015

15) Zhu Y, Thulborn K, Curnyn K, Goodwin J：Sixth cranial nerve palsy caused by compression from a dolichoectatic vertebral artery. J Neuro-Ophthalmol 25：134-135, 2005