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虚血脳モデルラットにおいて皮質梗塞巣の再現性を妨げている因子の一つに側副血行路の存在が挙げられる.私共は手術用顕微鏡下にラットの中大脳動脈走行を観察し, 得られた結果から再現性の高い梗塞モデル作成法について検討した.100匹のS-Dラットの中大脳動脈について, 起始部から前頭枝と頭頂枝に分岐する迄の走行について観察した.その結果, 中大脳動脈のearly bifurcation 8例, fenestration 4例, 前頭枝の分岐の見られないもの1例の計13例に走行のvariationが見られた.また, 中大脳動脈前頭枝を介する前大脳動脈からの側副血行が梗塞巣の再現性に大きな影響を与えることを考慮し, 起始部から前頭枝分岐部に至るまでを焼灼閉塞せしめた35例においては, TTC染色で梗塞巣を評価した結果, 33例94%において高度の皮質梗塞巣が得られた.皮質梗塞の高い再現性を得るには, 中大脳動脈近位部から前頭枝分岐直後までの閉塞が必要である.

Two patients with atherosclerotic ischemic cerebrovascular disease presented with transdural anastomoses. A 74-year-old woman had a cerebral infarct, and a 76-year-old man had dementia. Patients with atherosclerotic ischemic cerebrovascular disease may have developed transdural anastomoses, so care must be taken not to damage these functions during revascularization surgery.

A 14-year-old boy and a 11-year-old boy presented with subdural hematomas as complications of preexisting arachnoid cysts in the middle cranial fossa, manifesting as symptoms of raised intracranial pressure. Both had a history of heading the ball in a soccer game about 7 weeks and 2 days before the symptom occurred. There was no other head trauma, so these cases could be described as “heading injury.” Arachnoid cysts in the middle cranial fossa are often associated with subdural hematomas. We emphasize that mild trauma such as heading of the ball in a soccer game may cause subdural hematomas in patients with arachnoid cysts.

Two patients with atherosclerotic ischemic cerebrovascular disease presented with transdural anastomoses. A 74-year-old woman had a cerebral infarct, and a 76-year-old man had dementia. Patients with atherosclerotic ischemic cerebrovascular disease may have developed transdural anastomoses, so care must be taken not to damage these functions during revascularization surgery.