Furuse S, Matsumoto S, Tanaka Y, Ando S, Sawa H, Ishikawa S
No Shinkei Geka. 1982 Sep;10(9):1005-12.
A 67-year-old male was admitted to our clinic on May 1, 1981, because of mild confusion and a left hemiparesis. About 6 years ago, when he had a left-sided homonymous hemianopia, carotid angiography revealed moyamoya disease. CT scan on the admission showed an intracerebral hematoma in the right temporal lobe, which ruptured to the lateral ventricle. An angiogram demonstrated the net work of moyamoya vessels in the base of the brain and a "newly-appeared" aneurysm at the peripheral portion of the right anterior choroidal artery. This artery was shown on the previous angiogram also but did not bear the aneurysm. At the emergent operation the hematoma was evacuated and the aneurysm was excised, which was proved histologically to be a false aneurysm. Thirty-six cases of moyamoya diseases associated with aneurysm including the present case were reviewed. There were 44 aneurysms in this series. They were classified into groups--1) the major artery aneurysms arising from the major cerebral arterial segments; 2) the peripheral artery aneurysms arising from the distal segments of the peripheral cerebral arteries. The major artery aneurysms were found more frequently in the vertebro-basilar system, and the peripheral artery aneurysms in the basal ganglia, near or in the moyamoya vessels. Of 26 major artery aneurysms 12 were proved to be saccular aneurysms, 9 by surgeries and 3 by autopsy studies respectively. Of 18 cases of the peripheral group the aneurysms were excised operatively in two cases, and autopsy studies were performed in other two cases. The peripheral artery aneurysms were examined histologically in three cases; one was proved to be a false aneurysm, the other was thought to be a true aneurysm, and the third one was not verified. In 8 cases, the peripheral artery aneurysms disappeared on the follow-up angiograms and were supposed to be false aneurysms. From these reported cases, it may be suggested that major artery aneurysms are mainly true aneurysms and peripheral artery aneurysms are false aneurysms.
一名67岁男性于1981年5月1日因轻度意识模糊和左侧偏瘫入住我院。大约6年前，他出现左侧同向性偏盲时，颈动脉血管造影显示为烟雾病。入院时的CT扫描显示右颞叶脑内血肿，血肿破入侧脑室。血管造影显示脑底部烟雾状血管网以及右脉络膜前动脉外周部分有一个“新出现”的动脉瘤。在之前的血管造影中也显示了这条动脉，但当时没有动脉瘤。在急诊手术中，清除了血肿并切除了动脉瘤，组织学检查证实为假性动脉瘤。回顾了包括本病例在内的36例与动脉瘤相关的烟雾病病例。该系列共有44个动脉瘤。它们被分为两组：1）起源于大脑主要动脉段的主要动脉动脉瘤；2）起源于大脑外周动脉远端段的外周动脉动脉瘤。主要动脉动脉瘤在椎基底系统中更常见，外周动脉动脉瘤则在基底节区，靠近烟雾状血管或在烟雾状血管内。26个主要动脉动脉瘤中，12个被证实为囊状动脉瘤，分别有9个通过手术、3个通过尸检证实。外周组的18例中，2例手术切除了动脉瘤，另外2例进行了尸检。3例对外周动脉动脉瘤进行了组织学检查；1例被证实为假性动脉瘤，另1例被认为是真性动脉瘤，第3例未得到证实。8例中，外周动脉动脉瘤在随访血管造影中消失，推测为假性动脉瘤。从这些报道的病例来看，可能提示主要动脉动脉瘤主要是真性动脉瘤，而外周动脉动脉瘤是假性动脉瘤。
