Aplastic or twig-like middle cerebral artery の破格側副血行路起始部(A1)に発生した破裂脳動脈瘤の1 例
症例は60 歳女性.無症候性右中大脳動脈狭窄症として他施設で経過観察中,頭痛/意識障害で発症した.CT で右前頭葉脳内血腫を伴うくも膜下出血(SAH)を認め,CTA(computed tomographic angiography)/DSA ではM1 が描出されず,A1 より分岐後M1 欠損部を迂回し網状血管塊を介してM2 へ連続する側副血行がみられた.起始部に破裂瘤を認めコイル塞栓した.網状側副血行路を伴う特発性中大脳動脈閉塞症は,近年発生異常に伴う原始血管系の遺残(twig-like MCA)と考えられている.最近その1 亜型として,A1/A2 からM1 部を迂回し末梢へ至る破格側副血行路...
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Published in | 脳卒中 Vol. 40; no. 2; pp. 75 - 80 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | Japanese |
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一般社団法人 日本脳卒中学会
2018
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ISSN | 0912-0726 1883-1923 |
DOI | 10.3995/jstroke.10506 |
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Abstract | 症例は60 歳女性.無症候性右中大脳動脈狭窄症として他施設で経過観察中,頭痛/意識障害で発症した.CT で右前頭葉脳内血腫を伴うくも膜下出血(SAH)を認め,CTA(computed tomographic angiography)/DSA ではM1 が描出されず,A1 より分岐後M1 欠損部を迂回し網状血管塊を介してM2 へ連続する側副血行がみられた.起始部に破裂瘤を認めコイル塞栓した.網状側副血行路を伴う特発性中大脳動脈閉塞症は,近年発生異常に伴う原始血管系の遺残(twig-like MCA)と考えられている.最近その1 亜型として,A1/A2 からM1 部を迂回し末梢へ至る破格側副血行路内に網状血管が遺残するtype が提示された.本例もこれに相当する構造と思われる.起始部に発生したA1 動脈瘤6 例はすべて5 mm 以下であるが,5 例はSAH で発症している.血行動態的/構造的な脆弱性が示唆されており,本type の瘤は小型でも積極的治療適応に入る可能性がある. |
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AbstractList | 症例は60 歳女性.無症候性右中大脳動脈狭窄症として他施設で経過観察中,頭痛/意識障害で発症した.CT で右前頭葉脳内血腫を伴うくも膜下出血(SAH)を認め,CTA(computed tomographic angiography)/DSA ではM1 が描出されず,A1 より分岐後M1 欠損部を迂回し網状血管塊を介してM2 へ連続する側副血行がみられた.起始部に破裂瘤を認めコイル塞栓した.網状側副血行路を伴う特発性中大脳動脈閉塞症は,近年発生異常に伴う原始血管系の遺残(twig-like MCA)と考えられている.最近その1 亜型として,A1/A2 からM1 部を迂回し末梢へ至る破格側副血行路内に網状血管が遺残するtype が提示された.本例もこれに相当する構造と思われる.起始部に発生したA1 動脈瘤6 例はすべて5 mm 以下であるが,5 例はSAH で発症している.血行動態的/構造的な脆弱性が示唆されており,本type の瘤は小型でも積極的治療適応に入る可能性がある. |
Author | 小野, 智憲 日宇, 健 福田, 雄高 吉村, 正太 堤, 圭介 佐藤, 慧 高畠, 英昭 戸田, 啓介 松永, 裕希 平山, 航輔 牛島, 隆二郎 杣川, 知香 |
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References | 15) 内山拓,岡本浩昌,高口素史ら:一過性脳虚血発作を呈した2 年後に頭蓋内出血を生じたaplastic or twig-like middle cerebral artery の1例.Neurol Surg 44: 143–148, 2016 13) Rivera R, Sordo J, Badilla L, et al: Middle cerebral artery occlusion with moyamoya-like vessels and aneurysms. A report of two cases. Interv Neuroradiol 20: 96–99, 2014 4) Yaşargil MG, Smith RD: Association of middle cerebral artery anomalies with saccular aneurysms and Moyamoya disease. Surg Neurol 6: 39–43, 1976 7) 府川修,相原坦道,若狭治毅:モヤモヤ様血管網を伴った特発性中大脳動脈閉塞症 ─ 第2 報.1 剖検例の検討─.Neurol Surg 10: 1303–1310, 1982 18) Amagasaki K, Yagishita T, Kawataki T, et al: Middle cerebral artery aplasia associated with an aneurysm of the proximal anterior cerebral artery. Acta Neurochir (Wien) 140: 1313–1314, 1998 14) Tashiro R, Inoue T, Shibahara I, et al: Nonaneurysmal subarachnoid hemorrhage due to unfused or twiglike middle cerebral artery rupture: two case reports. J Stroke Cerebrovasc Dis 25: e77–78, 2016 3) Seo BS, Lee YS, Lee HG, et al: Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries. Neurosurgery 70: 1472–1480; discussion 1480, 2012 11) Bechan RS, van Rooij WJ: Endovascular treatment of a ruptured flow aneurysm of the heubner artery as part of a moyamoya collateral network in a young patient with an occluded middle cerebral artery. Interv Neuroradiol 20: 791–795, 2014 17) Han DH, Gwak HS, Chung CK: Aneurysm at the origin of accessory middle cerebral artery associated with middle cerebral artery aplasia: case report. Surg Neurol 42: 388–391, 1994 2) Cekirge HS, Peynircioglu B, Saatci I: Endovascular treatment of an “anterior cerebral artery” aneurysm in a patient with “embryonic unfused middle cerebral artery” anomaly: a case report. Neuroradiology 47: 690–694, 2005 8) 松永裕希,堤圭介,諸藤陽一ら:脳出血で発症したAplastic or twig-like middle cerebral artery の小児例.脳卒中の外 42: 51–57, 2014 10) Shin HS, Lee SH, Ryu CW, et al: Flow-related intracranial aneurysms associated with unfused arterial twigs relevant to different vascular anomalies: embryologic and hemodynamic considerations. Acta Neurochir (Wien) 156: 1637–1646, 2014 16) 井上明宏,河野兼久,福本真也ら:脳内出血にて発症したtwig-like middle cerebral artery に対してECA-MCA double anastomosis を施行した1 例.Neurol Surg 44: 463–471, 2016 19) Kim MS, Oh CW, Hur JW, et al: Aneurysms located at the proximal anterior cerebral artery and anterior communicating artery associated with middle cerebral artery aplasia: case report. Surg Neurol 64: 534–537, 2005 6) 府川修,相原坦道,石井完治ら:モヤモヤ血管を伴った特発性中大脳動脈閉塞症,第1 報: その臨床像と脳血管所見.脳卒中の外科研会講集 10: 36–41, 1981 9) Akkan K, Ucar M, Kilic K, et al: Unfused or twig-like middle cerebral artery. Eur J Radiol 84: 2013–2018, 2015 5) 中澤拓也,鈴木文夫,宮本義久ら:前大脳動脈近位部(A1)動脈瘤を伴った中大脳動脈起始部形成不全の1例.日外宝 54: 521–525, 1985 1) Liu HM, Lai DM, Tu YK, et al: Aneurysms in twig-like middle cerebral artery. Cerebrovasc Dis 20: 1–5, 2005 20) 高橋誠,藤本司,鈴木龍太ら:STA-MCA 吻合術後消失したと思われる,特発性中大脳動脈閉塞症に合併した脳動脈瘤の1 症例.Neurol Surg 25: 727–732, 1977 12) Otani N, Wada K, Sakakibara F, et al: A ruptured aneurysm located at a collateral artery that extended from the proximal A2 segment to the M1 segment, associated with an anomalous branch of the anterior choroidal artery and middle cerebral artery hypoplasia: case report. Neurol Med Chir (Tokyo) 54: 201–204, 2014 |
References_xml | – reference: 6) 府川修,相原坦道,石井完治ら:モヤモヤ血管を伴った特発性中大脳動脈閉塞症,第1 報: その臨床像と脳血管所見.脳卒中の外科研会講集 10: 36–41, 1981 – reference: 10) Shin HS, Lee SH, Ryu CW, et al: Flow-related intracranial aneurysms associated with unfused arterial twigs relevant to different vascular anomalies: embryologic and hemodynamic considerations. Acta Neurochir (Wien) 156: 1637–1646, 2014 – reference: 17) Han DH, Gwak HS, Chung CK: Aneurysm at the origin of accessory middle cerebral artery associated with middle cerebral artery aplasia: case report. Surg Neurol 42: 388–391, 1994 – reference: 18) Amagasaki K, Yagishita T, Kawataki T, et al: Middle cerebral artery aplasia associated with an aneurysm of the proximal anterior cerebral artery. Acta Neurochir (Wien) 140: 1313–1314, 1998 – reference: 3) Seo BS, Lee YS, Lee HG, et al: Clinical and radiological features of patients with aplastic or twiglike middle cerebral arteries. Neurosurgery 70: 1472–1480; discussion 1480, 2012 – reference: 13) Rivera R, Sordo J, Badilla L, et al: Middle cerebral artery occlusion with moyamoya-like vessels and aneurysms. A report of two cases. Interv Neuroradiol 20: 96–99, 2014 – reference: 7) 府川修,相原坦道,若狭治毅:モヤモヤ様血管網を伴った特発性中大脳動脈閉塞症 ─ 第2 報.1 剖検例の検討─.Neurol Surg 10: 1303–1310, 1982 – reference: 19) Kim MS, Oh CW, Hur JW, et al: Aneurysms located at the proximal anterior cerebral artery and anterior communicating artery associated with middle cerebral artery aplasia: case report. Surg Neurol 64: 534–537, 2005 – reference: 1) Liu HM, Lai DM, Tu YK, et al: Aneurysms in twig-like middle cerebral artery. Cerebrovasc Dis 20: 1–5, 2005 – reference: 14) Tashiro R, Inoue T, Shibahara I, et al: Nonaneurysmal subarachnoid hemorrhage due to unfused or twiglike middle cerebral artery rupture: two case reports. J Stroke Cerebrovasc Dis 25: e77–78, 2016 – reference: 4) Yaşargil MG, Smith RD: Association of middle cerebral artery anomalies with saccular aneurysms and Moyamoya disease. Surg Neurol 6: 39–43, 1976 – reference: 11) Bechan RS, van Rooij WJ: Endovascular treatment of a ruptured flow aneurysm of the heubner artery as part of a moyamoya collateral network in a young patient with an occluded middle cerebral artery. Interv Neuroradiol 20: 791–795, 2014 – reference: 8) 松永裕希,堤圭介,諸藤陽一ら:脳出血で発症したAplastic or twig-like middle cerebral artery の小児例.脳卒中の外 42: 51–57, 2014 – reference: 9) Akkan K, Ucar M, Kilic K, et al: Unfused or twig-like middle cerebral artery. Eur J Radiol 84: 2013–2018, 2015 – reference: 16) 井上明宏,河野兼久,福本真也ら:脳内出血にて発症したtwig-like middle cerebral artery に対してECA-MCA double anastomosis を施行した1 例.Neurol Surg 44: 463–471, 2016 – reference: 12) Otani N, Wada K, Sakakibara F, et al: A ruptured aneurysm located at a collateral artery that extended from the proximal A2 segment to the M1 segment, associated with an anomalous branch of the anterior choroidal artery and middle cerebral artery hypoplasia: case report. Neurol Med Chir (Tokyo) 54: 201–204, 2014 – reference: 20) 高橋誠,藤本司,鈴木龍太ら:STA-MCA 吻合術後消失したと思われる,特発性中大脳動脈閉塞症に合併した脳動脈瘤の1 症例.Neurol Surg 25: 727–732, 1977 – reference: 2) Cekirge HS, Peynircioglu B, Saatci I: Endovascular treatment of an “anterior cerebral artery” aneurysm in a patient with “embryonic unfused middle cerebral artery” anomaly: a case report. Neuroradiology 47: 690–694, 2005 – reference: 15) 内山拓,岡本浩昌,高口素史ら:一過性脳虚血発作を呈した2 年後に頭蓋内出血を生じたaplastic or twig-like middle cerebral artery の1例.Neurol Surg 44: 143–148, 2016 – reference: 5) 中澤拓也,鈴木文夫,宮本義久ら:前大脳動脈近位部(A1)動脈瘤を伴った中大脳動脈起始部形成不全の1例.日外宝 54: 521–525, 1985 |
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Snippet | 症例は60 歳女性.無症候性右中大脳動脈狭窄症として他施設で経過観察中,頭痛/意識障害で発症した.CT で右前頭葉脳内血腫を伴うくも膜下出血(SAH)を... |
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SubjectTerms | flow-related aneurysm ruptured A1 aneurysm twig-like middle cerebral artery twig-like networks of an anomalous collateral artery unfused middle cerebral artery |
Title | Aplastic or twig-like middle cerebral artery の破格側副血行路起始部(A1)に発生した破裂脳動脈瘤の1 例 |
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