1 Case report 後硬膜動脈から延髄外側への穿通枝を認めた 1 例 A case of Lateral medullary artery arise from the Posterior meningeal artery 伊藤真史 泉孝嗣 西堀正洋 今井資 玉利洋介 塚田哲也 石田衛 クロップ明日香 若 林俊彦 Masashi I, Takashi I, Nishihori M, Tasuku I, Yousuke T, Tetsuya T, Mamoru I, Asuka K, Toshihiko W 名古屋大学附属病院脳神経外科 Department of Neurosurgery, Nagoya university graduate school of Medicine 伊藤真史名古屋大学附属病院脳神経外科 466-8560 名古屋市昭和区鶴舞町 65 番地 電話番号 : 052-741-2353 メールアドレス mercy_0607@yahoo.co.jp キーワード
2 Posterior Meningeal Artery, Wallenberg Syndrome, ischemic stroke 本論文を, 日本脳神経血管内治療学会機関誌 JNET Journal of Neuroendovascular Therapy に投稿するにあたり, 筆頭著者, 共著者によって, 国内外の他雑誌に掲載ないし投稿さ れていないことを誓約致します.
1 1 穿 2 A case of Lateral medullary artery arise from the Posterior 3 meningeal artery 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Posterior Meningeal Artery : PMA 梗 1 69 梗 PMA 穿 DSA D angiography PMA 穿 20 21
2 22 23 24 25 26 27 28 Posterior Meningeal Artery : PMA vertebral artery : VA Ascending pharyngeal artery APA Occipital artery OA 1) (Posterior inferior cerebellar artery :PICA) PMA PICA 2)3) 29 PMA 30 31 32 33 34 35 36 PMA 穿 梗 DSA 3D angiography 穿 37 38 39 40 41 69 CT MRI DSA Cognard Type Fig.1 γ 42 γ 43 44 45 parasinus
3 46 47 48 inferior vermian vein main feeder OA PMA n-butyl-2-cyanoacrylate NBCA 49 OA 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 PMA Marathon Covidien japan, Tokyo TENROU KANEKA MEDIX, Oosaka PMA Fig.2 A B 穿 Fig.2 C DSA 3D angiography 穿 Fig.2 A B, Fig.3 Fig.2 D glue 穿 MRI Fig.4 Wallenberg 65 66 67 68 PMA VA 1) 穿 VA PICA 69 4) 5) 6) 3D angiography PMA
4 70 71 72 73 74 75 76 穿 梗 PMA PICA 7 PICA PMA anomaly 8 PICA PMA 9)10) PICA PMA VA PMA 77 10)11) 78 79 80 81 82 83 84 VA PMA PICA lateral medullary segment 穿 middle meningeal artery MMA glue PMA glue Posterior spinal artery PSA 85 梗 12) MMA PMA 86 PSA glue 87 88 梗 PMA 穿 89 90 91 92 93 PMA 穿 PMA 梗
5 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 References 1) Komiyama M, Functional anatomy of the brain and spinal vessels, Tokyo, medical view, 2007: 281 2)Arai A, Miyamoto H, Ashida N, et al. Spontaneous occlusion of PICA-involved dissecting aneurysm with development of a collateral channel from the posterior meningeal artery. No Shinkei Geka. 2012;40(11):997-1002. 3) Tsutsumi M, Kazekawa K, Aikawa H, et al. Development of unusual collateral channel from the posterior meningeal artery after endovascular proximal occlusion of the posterior inferior cerebellar artery. Neurol Med Chir (Tokyo) 2007; 47(11) 503-505 4) Kato S, Takikawa M, Ishihara S, et al. Pathologic Reappraisal of Wallenberg Syndrome A Pathologic Distribution Study and Analysis of Literature. Yonago Acta Med 2014; 57:1 14 5) Cho IY, Hwang SK. A Case of Lateral Medullary Infarction after Endovascular Trapping of the Vertebral Artery Dissecting Aneurysm, J Korean Neurosurg Soc 2012, 51:160-163.
6 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 6) Kim JS. Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients. Brain 2003, 126:1864-1872 7) Ogawa T, Fujita H, lnugami A, et al. Anomalous origin of the posterior inferior cerebellar artery from the posterior meningeal artery. AJNR Am J Neuroradiol. 1991, 12(1):186. 8 Tanohata K, Maehara T, Noda M, et al. Anomalous origin of the posterior meningeal artery from the lateral medullary segment of the posterior inferior cerebellar artery. Neuroradiology. 1987, 29(1):89-92 9) Tanohata K, Normal Variations of the Etra- & Intra-cranial Vessels, Tokyo, medicalview, 2000: 102-103 10) Martins C, Yasuda A, Campero A et al. Microsurgical anatomy of the dural arteries. Neurosurgery. 2005, 56:211-251 11) Newton TH. The Anterior and Posterior Meningeal Branches of the Vertebral Artery. Radiology. 1968 91(2):271-279 12) Raphael B, Hassan H, Caroline G, et al. Posterior cervical spinal cord infarction complicating the treatment of an intracranial dural arteriovenous fistula embolization. J Neurosurg Spine, 2006 5:79 82 138 139 140 141 Figure 1 Cognard
7 142 Type A B 143 144 Figure 2 A,B 145 146 穿 C,D 穿 147 148 Figure 3 PMA 穿 149 A,B,C 3D angiography D,E MPR axial 150 F E MRIT2WI 151 152 Figure 4 MRI DWI high