Abstract
71歳,男性.視力視野障害で発症した左海綿静脈洞部巨大内頚動脈瘤で,proximal ligationにhigh-flow bypassを併用し,術中および術後1ヵ月目に完全閉塞を確認した.しかし2ヵ月後に左動眼神経麻痺が出現し,high-flow bypassを介して動脈瘤の再増大を認めた.遠位側クリッピングを行って動脈瘤は完全閉塞し,症状は改善した.海綿静脈洞部巨大脳動脈瘤はproximal ligation+high-flow bypassが一般的な治療だが,今回のようにいったん閉塞した動脈瘤がbypassを介して再増大をきたすこともあるため,初回よりトラッピングが理想的と考えられた.
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