松島 俊夫

顆窩経由法(別名 後頭顆上部頸静脈結節経由法)による傍正中後下小脳動脈分岐部動脈瘤のクリッピング

We successfully clipped a right VA-PICA aneurysm through the transcondylar fossa approach. The usefullness of this approach is reported. A 66-year old female was admitted because of moderate headache, nausea and vomiting. CT scan showed subarachnoid hemorrhage particularly in the cisterns of the right posterior fossa. Vertebral angiography revealed a right VA-PICA aneurysm located 5.3 mm apart from the midline and 6 mm inferior to the internal auditory meatus. Direct clipping was done through the transcondylar fossa approach. A straight clip was applied through the space between the vagus and hypoglossal nerves. Postoperative hypoglossal nerve palsy and hoarseness disappeared within a week. The postoperative angiography revealed complete obliteration of the aneurysm. The transcondylar fossa approach differs from the transcondylar approach. In the transcondylar fossa approach, the condylar fossa and jugular tubercle are extradurally drilled. The occipital condyle is kept intact so that the atlanto-occipital joint movement is well preserved. This approach is very useful for VA or VA-PICA aneurysm, giving a wider operative field and closer access.

Diamox負荷99mTc-HMPAO SPECTを用いたモヤモヤ病の脳循環の評価

Diamox負荷99mTc-HMPAO SPECTを用いてモヤモヤ病患者の脳循環を評価した。対象はモヤモヤ病9例 (小児4例, 成人5例) である。安静時では9例中6例に血流低下を認めた。3例では血流低下を認めなかった。Diamoxテストは9例中6例で陽性であったが, 安静時に異常がみられなかった3例はすべて陽性であった。以上より, Diamox負荷99mTc-HMPAO SPECTはモヤモヤ病患者の脳循環の評価に有用であった。