もやもや病の側副血行路に生じた動脈瘤破裂に対する母血管閉塞術を施行し，視力障害をきたした1例
症例は55歳，女性．頭痛と見当識障害の精査にて頭部magnetic resonance imaging（MRI）を施行し，硬膜下血腫およびもやもや病が疑われ当院紹介となった．脳血管造影（digital subtraction angiography：DSA）にてanterior ethmoidal arteryの側副血行路上に仮性動脈瘤を認め硬膜下血腫の出血源と判断し，母血管閉塞術を施行した．塞栓直後のDSAで動脈瘤消失とcentral retinal arteryおよびretinal choroidal brushの描出を確認するも，麻酔覚醒時には視力障害を認めた．もやもや病の側副血行路上の...
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| Published in | 脳卒中の外科 Vol. 51; no. 5; pp. 442 - 447 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2023
日本脳卒中の外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.51.442 |
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| Abstract | 症例は55歳，女性．頭痛と見当識障害の精査にて頭部magnetic resonance imaging（MRI）を施行し，硬膜下血腫およびもやもや病が疑われ当院紹介となった．脳血管造影（digital subtraction angiography：DSA）にてanterior ethmoidal arteryの側副血行路上に仮性動脈瘤を認め硬膜下血腫の出血源と判断し，母血管閉塞術を施行した．塞栓直後のDSAで動脈瘤消失とcentral retinal arteryおよびretinal choroidal brushの描出を確認するも，麻酔覚醒時には視力障害を認めた．もやもや病の側副血行路上の動脈瘤破裂に対する母血管塞栓術は，塞栓性合併症を生じる可能性があり，安易な選択は避けるべきであると考えられた． |
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| AbstractList | 症例は55歳，女性．頭痛と見当識障害の精査にて頭部magnetic resonance imaging（MRI）を施行し，硬膜下血腫およびもやもや病が疑われ当院紹介となった．脳血管造影（digital subtraction angiography：DSA）にてanterior ethmoidal arteryの側副血行路上に仮性動脈瘤を認め硬膜下血腫の出血源と判断し，母血管閉塞術を施行した．塞栓直後のDSAで動脈瘤消失とcentral retinal arteryおよびretinal choroidal brushの描出を確認するも，麻酔覚醒時には視力障害を認めた．もやもや病の側副血行路上の動脈瘤破裂に対する母血管塞栓術は，塞栓性合併症を生じる可能性があり，安易な選択は避けるべきであると考えられた． 「要旨」症例は55歳, 女性. 頭痛と見当識障害の精査にて頭部magnetic resonance imaging(MRI)を施行し, 硬膜下血腫およびもやもや病が疑われ当院紹介となった. 脳血管造影(digital subtraction angiography : DSA)にてanterior ethmoidal arteryの側副血行路上に仮性動脈瘤を認め硬膜下血腫の出血源と判断し, 母血管閉塞術を施行した. 塞栓直後のDSAで動脈瘤消失とcentral retinal arteryおよびretinal choroidal brushの描出を確認するも, 麻酔覚醒時には視力障害を認めた. もやもや病の側副血行路上の動脈瘤破裂に対する母血管塞栓術は, 塞栓性合併症を生じる可能性があり, 安易な選択は避けるべきであると考えられた. |
| Author | 池田, 峻介 池田, 俊貴 神山, 信也 柳川, 太郎 柴田, 碧人 根木, 宏明 |
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| References | 10) Suzuki J, Takaku A : Cerebrovascular“moyamoya”disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20: 288-299, 1969 7) Oppenheim JS, Gennuso R, Sacher M, et al : Acute atraumatic subdural hematoma associated with moyamoya disease in an African-American. Neurosurgery 28: 616-618, 1991 12) Vijayasaradhi M, Prasad VB : Moyamoya disease presenting as bilateral acute subdural hematomas without deficits. Asian J Neurosurg 12: 228-231, 2017 6) Ni W, Jiang H, Xu B, et al : Treatment of aneurysms in patients with moyamoya disease: a 10-year single-center experience. J Neurosurg 128: 1813-1822, 2018 1) Hou K, Li G, Luan T, et al : The prospects and pitfalls in the endovascular treatment of moyamoya disease-associated intracranial aneurysms. Neurosurg Rev 44: 261-271, 2021 3) Kawaguchi S, Sakaki T, Kakizaki T, et al : Clinical features of the haemorrhage type moyamoya disease based on 31 cases. Acta Neurochir (Wien) 138: 1200-1210, 1996 4) 川上喜代志，高橋慎一郎，園部真，ほか：モヤモヤ現象に合併した亜急性硬膜下血腫─症例報告と文献的考察．No Shinkei Geka 16: 205-209, 1988 2) Hou K, Wu W, Liu Y, et al : Role of the ophthalmic artery in the endovascular treatment for intracranial vascular diseases. Acta Neurol Belg 121: 321-330, 2021 13) Yu JL, Wang HL, Xu K, et al : Endovascular treatment of intracranial aneurysms associated with moyamoya disease or moyamoya syndrome. Interv Neuroradiol 16: 240-248, 2010 5) Kim S, Jang CK, Park EK, et al : Clinical features and outcomes of intracranial aneurysm associated with moyamoya disease. J Clin Neurol 16: 624-632, 2020 8) Saeki N, Nakazaki S, Kubota M, et al : Hemorrhagic type moyamoya disease. Clin Neurol Neurosurg 99（Suppl 2）: S196-S201, 1997 11) Takeuchi S, Ichikawa A, Koike T, et al : Acute subdural hematoma in young patient with moyamoya disease─case report. Neurol Med Chir（Tokyo）32: 80-83, 1992 9) Shen WC, Lee WY : Moyamoya disease causes acute subdural hematomas and sudden death: a case report. Zhonghua Yi Xue Za Zhi（Taipei）61: 619-623, 1998 |
| References_xml | – reference: 2) Hou K, Wu W, Liu Y, et al : Role of the ophthalmic artery in the endovascular treatment for intracranial vascular diseases. Acta Neurol Belg 121: 321-330, 2021 – reference: 10) Suzuki J, Takaku A : Cerebrovascular“moyamoya”disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20: 288-299, 1969 – reference: 5) Kim S, Jang CK, Park EK, et al : Clinical features and outcomes of intracranial aneurysm associated with moyamoya disease. J Clin Neurol 16: 624-632, 2020 – reference: 7) Oppenheim JS, Gennuso R, Sacher M, et al : Acute atraumatic subdural hematoma associated with moyamoya disease in an African-American. Neurosurgery 28: 616-618, 1991 – reference: 4) 川上喜代志，高橋慎一郎，園部真，ほか：モヤモヤ現象に合併した亜急性硬膜下血腫─症例報告と文献的考察．No Shinkei Geka 16: 205-209, 1988 – reference: 11) Takeuchi S, Ichikawa A, Koike T, et al : Acute subdural hematoma in young patient with moyamoya disease─case report. Neurol Med Chir（Tokyo）32: 80-83, 1992 – reference: 8) Saeki N, Nakazaki S, Kubota M, et al : Hemorrhagic type moyamoya disease. Clin Neurol Neurosurg 99（Suppl 2）: S196-S201, 1997 – reference: 12) Vijayasaradhi M, Prasad VB : Moyamoya disease presenting as bilateral acute subdural hematomas without deficits. Asian J Neurosurg 12: 228-231, 2017 – reference: 6) Ni W, Jiang H, Xu B, et al : Treatment of aneurysms in patients with moyamoya disease: a 10-year single-center experience. J Neurosurg 128: 1813-1822, 2018 – reference: 13) Yu JL, Wang HL, Xu K, et al : Endovascular treatment of intracranial aneurysms associated with moyamoya disease or moyamoya syndrome. Interv Neuroradiol 16: 240-248, 2010 – reference: 1) Hou K, Li G, Luan T, et al : The prospects and pitfalls in the endovascular treatment of moyamoya disease-associated intracranial aneurysms. Neurosurg Rev 44: 261-271, 2021 – reference: 3) Kawaguchi S, Sakaki T, Kakizaki T, et al : Clinical features of the haemorrhage type moyamoya disease based on 31 cases. Acta Neurochir (Wien) 138: 1200-1210, 1996 – reference: 9) Shen WC, Lee WY : Moyamoya disease causes acute subdural hematomas and sudden death: a case report. Zhonghua Yi Xue Za Zhi（Taipei）61: 619-623, 1998 |
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| Snippet | 症例は55歳，女性．頭痛と見当識障害の精査にて頭部magnetic resonance imaging（MRI）を施行し，硬膜下血腫およびもやもや病が疑われ当院紹介となった．脳血管造... 「要旨」症例は55歳, 女性. 頭痛と見当識障害の精査にて頭部magnetic resonance imaging(MRI)を施行し, 硬膜下血腫およびもやもや病が疑われ当院紹介となった. 脳血管造... |
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| Title | もやもや病の側副血行路に生じた動脈瘤破裂に対する母血管閉塞術を施行し，視力障害をきたした1例 |
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