クモ膜下出血例における動脈解離の病理形態
「はじめに」近年, 椎骨脳底動脈系を中心に, クモ膜下出血で発症する解離性動脈瘤の報告が増加し, 様々な検討が行われてきた. しかし動脈解離の病理形態や血管撮影所見は症例により異なる点が多く, 本疾患の真の病態についてはなお曖昧なのが現状である. 報告の中には, いわゆる内頸動脈背側動脈瘤や紡錘形動脈瘤, あるいは血管撮影で出血源の同定できないクモ膜下出血例についても, 本病態との関連に注目するものもみられる. 本報告では頭蓋内動脈解離の臨床像をより明確にする目的で, クモ膜下出血剖検例の中で解離性動脈瘤または動脈解離病態の関与が疑われた10例を対象に, 病理組織学的所見と血管撮影所見を中心に...
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| Published in | 脳卒中の外科 Vol. 25; no. 3; pp. 169 - 176 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
31.05.1997
日本脳卒中の外科研究会 |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs1987.25.3_169 |
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| Abstract | 「はじめに」近年, 椎骨脳底動脈系を中心に, クモ膜下出血で発症する解離性動脈瘤の報告が増加し, 様々な検討が行われてきた. しかし動脈解離の病理形態や血管撮影所見は症例により異なる点が多く, 本疾患の真の病態についてはなお曖昧なのが現状である. 報告の中には, いわゆる内頸動脈背側動脈瘤や紡錘形動脈瘤, あるいは血管撮影で出血源の同定できないクモ膜下出血例についても, 本病態との関連に注目するものもみられる. 本報告では頭蓋内動脈解離の臨床像をより明確にする目的で, クモ膜下出血剖検例の中で解離性動脈瘤または動脈解離病態の関与が疑われた10例を対象に, 病理組織学的所見と血管撮影所見を中心に検討を行った. あわせて本疾患診断上の問題につき, 若干の考察を行った. 「対象および方法」対象は, 解離性動脈瘤または関連の病態が疑われたクモ膜下出血 (SAH) 剖検10例である. |
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| AbstractList | 「はじめに」近年, 椎骨脳底動脈系を中心に, クモ膜下出血で発症する解離性動脈瘤の報告が増加し, 様々な検討が行われてきた. しかし動脈解離の病理形態や血管撮影所見は症例により異なる点が多く, 本疾患の真の病態についてはなお曖昧なのが現状である. 報告の中には, いわゆる内頸動脈背側動脈瘤や紡錘形動脈瘤, あるいは血管撮影で出血源の同定できないクモ膜下出血例についても, 本病態との関連に注目するものもみられる. 本報告では頭蓋内動脈解離の臨床像をより明確にする目的で, クモ膜下出血剖検例の中で解離性動脈瘤または動脈解離病態の関与が疑われた10例を対象に, 病理組織学的所見と血管撮影所見を中心に検討を行った. あわせて本疾患診断上の問題につき, 若干の考察を行った. 「対象および方法」対象は, 解離性動脈瘤または関連の病態が疑われたクモ膜下出血 (SAH) 剖検10例である. |
| Author | 遠藤, 俊郎 高羽, 通康 西蔦, 美知春 扇一, 恒章 高久, 晃 栗本, 昌紀 |
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| References | 24) van Donselaar CA, Stefanko SZ, van del Kwast TH, et al : Basilar artery giant fusiform aneurysms caused by congenital defect of the internal elastic lamina and media. Clin Neuropathol 7 : 68-72, 1988 27) Yonas H, Agamanolis D, Takaoka Y, et al : Dissecting intracranial aneurysms. Surg Neurol 8 : 407-415, 1977 9) Hosoda K, Fujitu S, Kawagichi T, et al : Spontaneous dissecting aneurysms of the basilar artery presenting with a subarachnoid hemorrhage. Report of two cases. J Neurosurg 75 : 628-633, 1991 2) Alexander CB, Burger PC, Goree JA : Dissecting aneurysms of the basilar artery in two patients. Stroke 10 : 294-299, 1979 6) Farrell MA, Gilbert JJ, Kaufmann JC : Fatal intracranial dissection : Clinical pathological correlation. J Neurol Neurosurg Psychiatry 48 : 111-121, 1985 22) Shimoji T, Bando K, Nakajima K, et al : Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61 : 1038-1046, 1984 14) Massound TF, Anslow P, Molyneux AJ : Subarachnoid hemorrhage following spontaneous intracranial carotid artery dissection. Neuroradiology 34 : 33-35, 1992 13) Manz HJ, Luessenhop AJ : Dissecting aneurysm of intracranial vertebral artery : Case report and review of literature. J Neurol 230 : 25-35, 1983 4) Canhao P, Ferro JM, Pinto AN, et al : Perimesencephalic andnonperimesencephalic subarachnoid hemorrhages with negative angiograms. Acta Neurochir (Wien) 132 : 14-19, 1995 3) Berger MS, Wilson CB : Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the leterature. J Neurosurg 61 : 882-894, 1984 15) Mizutani T, Aruga T, Kirino T, et al : Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36 : 905-913, 1995 1) Adams HP Jr, Aschenbrener CA, Kassel NF, et al : Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 39 : 773-775, 1982 23) Stehbens WE : Dissecting aneurysms of the cerebral arteries. In : Pathology of the Cerebral Blood Vessels, The CV Mosby Com, Saint Louis, 1972, pp440-470 25) Yamaura A, Watanabe Y, Saeki N : Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72 : 183-188, 1990 26) Yasargil MG : Internal carotid artery aneurysm, distal medi al wall aneurysm and aneurysms of superior wall of internal carotid artery. In : Microneurosurgery, Vol2, George Thieme Verlag, Stuttgart/New York, 1984, pp58-59 12) Kitanaka C, Tanaki J, Kuwahara M, et al : Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80 : 667-674, 1994 21) Sasaki O, Ogawa H, Koike T, et al : A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75 : 874-882, 1991 20) Sasaki O, Koike T, Tanaka R, et al : Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. J Neurosurg 74 : 504-507, 1991 16) Mizutani T : A fetal, chronically growing basilar artery : A new type of dissecting aneurysm. J Neurosurg 84 : 962-971, 1966 18) Pozzati E, Andreoli A, Limoni P, et al : Dissecting aneurysm of the vertebrobasilar system : Study of 16 cases. Surg Neurol 41 : 119-124, 1994 11) Iwama T, Andoh T, Sakai N, et al : Dissecting and fusiform aneurysms of vertebro-basilar systems; MR imaging. Neuroradiology 32 : 272-279, 1990 5) Endo S, Nishijima M, Nomura H, et al : A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage; Report of three autopsied cases and review of the literature. Neurosurgery 33 : 732-738, 1993 10) Ide Y, Fukushima T, Yamamoto M, et al : Vertebral dissecting aneurysm associated with medial mucoid degeneration. Case report and review of literature. Neurol Med Chir (Tokyo) 26 : 888-894, 1986 (Jpn 19) Rinkel GJE, van Gijn J, Wijdicks EFM : Subarachnoid hemorrhagem without detectable aneurysm. A review of the causes. Stroke 24 : 1403-1409, 1993 7) Friedman AH, Drake CG : Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60 : 325-334, 1984 8) Fujiwara S, Yokoyama N, Fujii T, et al : Repeat angiography and magnetic resonance imaging (MRI) of dissecting aneurysms of the intracranial vertebral artery. Report of four cases. Acta Neurochir (Wien) 121 : 123-129, 1993 17) Nakagawa F, Kobayashi S, Takemae T, et al : Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 65 : 303-308, 1986 |
| References_xml | – reference: 22) Shimoji T, Bando K, Nakajima K, et al : Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61 : 1038-1046, 1984 – reference: 4) Canhao P, Ferro JM, Pinto AN, et al : Perimesencephalic andnonperimesencephalic subarachnoid hemorrhages with negative angiograms. Acta Neurochir (Wien) 132 : 14-19, 1995 – reference: 5) Endo S, Nishijima M, Nomura H, et al : A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage; Report of three autopsied cases and review of the literature. Neurosurgery 33 : 732-738, 1993 – reference: 20) Sasaki O, Koike T, Tanaka R, et al : Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. J Neurosurg 74 : 504-507, 1991 – reference: 23) Stehbens WE : Dissecting aneurysms of the cerebral arteries. In : Pathology of the Cerebral Blood Vessels, The CV Mosby Com, Saint Louis, 1972, pp440-470 – reference: 25) Yamaura A, Watanabe Y, Saeki N : Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72 : 183-188, 1990 – reference: 1) Adams HP Jr, Aschenbrener CA, Kassel NF, et al : Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 39 : 773-775, 1982 – reference: 7) Friedman AH, Drake CG : Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60 : 325-334, 1984 – reference: 27) Yonas H, Agamanolis D, Takaoka Y, et al : Dissecting intracranial aneurysms. Surg Neurol 8 : 407-415, 1977 – reference: 21) Sasaki O, Ogawa H, Koike T, et al : A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75 : 874-882, 1991 – reference: 6) Farrell MA, Gilbert JJ, Kaufmann JC : Fatal intracranial dissection : Clinical pathological correlation. J Neurol Neurosurg Psychiatry 48 : 111-121, 1985 – reference: 8) Fujiwara S, Yokoyama N, Fujii T, et al : Repeat angiography and magnetic resonance imaging (MRI) of dissecting aneurysms of the intracranial vertebral artery. Report of four cases. Acta Neurochir (Wien) 121 : 123-129, 1993 – reference: 14) Massound TF, Anslow P, Molyneux AJ : Subarachnoid hemorrhage following spontaneous intracranial carotid artery dissection. Neuroradiology 34 : 33-35, 1992 – reference: 2) Alexander CB, Burger PC, Goree JA : Dissecting aneurysms of the basilar artery in two patients. Stroke 10 : 294-299, 1979 – reference: 11) Iwama T, Andoh T, Sakai N, et al : Dissecting and fusiform aneurysms of vertebro-basilar systems; MR imaging. Neuroradiology 32 : 272-279, 1990 – reference: 26) Yasargil MG : Internal carotid artery aneurysm, distal medi al wall aneurysm and aneurysms of superior wall of internal carotid artery. In : Microneurosurgery, Vol2, George Thieme Verlag, Stuttgart/New York, 1984, pp58-59 – reference: 16) Mizutani T : A fetal, chronically growing basilar artery : A new type of dissecting aneurysm. J Neurosurg 84 : 962-971, 1966 – reference: 10) Ide Y, Fukushima T, Yamamoto M, et al : Vertebral dissecting aneurysm associated with medial mucoid degeneration. Case report and review of literature. Neurol Med Chir (Tokyo) 26 : 888-894, 1986 (Jpn) – reference: 17) Nakagawa F, Kobayashi S, Takemae T, et al : Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 65 : 303-308, 1986 – reference: 24) van Donselaar CA, Stefanko SZ, van del Kwast TH, et al : Basilar artery giant fusiform aneurysms caused by congenital defect of the internal elastic lamina and media. Clin Neuropathol 7 : 68-72, 1988 – reference: 15) Mizutani T, Aruga T, Kirino T, et al : Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36 : 905-913, 1995 – reference: 19) Rinkel GJE, van Gijn J, Wijdicks EFM : Subarachnoid hemorrhagem without detectable aneurysm. A review of the causes. Stroke 24 : 1403-1409, 1993 – reference: 3) Berger MS, Wilson CB : Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the leterature. J Neurosurg 61 : 882-894, 1984 – reference: 9) Hosoda K, Fujitu S, Kawagichi T, et al : Spontaneous dissecting aneurysms of the basilar artery presenting with a subarachnoid hemorrhage. Report of two cases. J Neurosurg 75 : 628-633, 1991 – reference: 18) Pozzati E, Andreoli A, Limoni P, et al : Dissecting aneurysm of the vertebrobasilar system : Study of 16 cases. Surg Neurol 41 : 119-124, 1994 – reference: 13) Manz HJ, Luessenhop AJ : Dissecting aneurysm of intracranial vertebral artery : Case report and review of literature. J Neurol 230 : 25-35, 1983 – reference: 12) Kitanaka C, Tanaki J, Kuwahara M, et al : Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80 : 667-674, 1994 |
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| Title | クモ膜下出血例における動脈解離の病理形態 |
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