Saltzman IIIc형 잔류삼차동맥변이를 동반한 전맥락막동맥 과형성 변이

Hyperplastic Variant of Anterior Choroidal Artery with Saltzman IIIc Type Persistent Trigeminal Artery Variant

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J Korean Neurol Assoc. 2024;42(3):290-291

Publication date (electronic) : August 1, 2024

doi : http://dx.doi.org/10.17340/jkna.2023.0108

JiSoo Kim, MD , Eunbyol Hwang, MD , Yun Jeong Hong, MD , Seong Hoon Kim, MD , Myung Ah Lee, MD , Jeong Wook Park, MD , Seunghee Na, MD ^a, Young-Do Kim, MD ^a, Yoo Dong Won, MD ^b, Si Baek Lee, MD

Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea

^aDepartment of Neurology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

^bDepartment of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea

김지수, 황은별, 홍윤정, 김성훈, 이명아, 박정욱, 나승희^a, 김영도^a, 원유동^b, 이시백

가톨릭대학교 의정부성모병원 신경과

^a가톨릭대학교 인천성모병원 신경과

^b가톨릭대학교 의정부성모병원 영상의학과

Address for correspondence Si Baek Lee, MD Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonboro, Uijeongbu 11765, Korea Tel.: +82-31-820-5357 Fax: +82-31-821-3662 E-mail: seeback@catholic.ac.kr

received : October 31, 2023 , rev-recd : March 3, 2024 , accepted : March 4, 2024 .

68세 남자가 혼돈과 언어장애로 내원하였다. 신경계진찰에서 운동실어증과 지남력 저하가 보였으나 운동, 감각 및 소뇌기능은 정상이었다. 컴퓨터단층촬영에서 좌측 중대뇌동맥 상분절 폐색 소견을 보였고 뇌자기공명영상 확산강조영상에서 좌측 전두엽에 고신호강도를 보여 좌측 중대뇌동맥경색으로 진단하였다. 뇌혈관조영술에서 좌측 내경동맥 해면분절에서 기저동맥을 거치지 않고 후하소뇌동맥으로 주행하는 Saltzman IIIc형의 원시삼차신경동맥 변이가 관찰되었고(Fig. A, C, E) [1] 후교통동맥에서 후대뇌동맥이 분지하였으며 과증식 소견의 전맥락동맥이 후대뇌동맥의 후측두엽 영역으로 주행하였다(Fig. A, B, D). 원시삼차동맥은 성인에서 관찰되는 경동맥-기저동맥 간 연결 중 가장 흔한 동맥으로 0.1-0.6%에서 관찰되며[1] 후대뇌동맥 영역으로 공급되는 과증식 전맥락동맥은 원시전맥락동맥과 후대뇌동맥 원위부의 불완전한 병합에서 기인하며 2.3%에서 관찰된다고 알려져 있다[2,3]. 본 증례는 원시삼차동맥 변이와 과증식 전맥락동맥이 공존하는 드문 증례로 이에 보고하고자 한다.

Figure.

(A) Brain 3D CT angiography shows the left AChA (arrow), fetal type of PCA (dashed arrow), SCA (open arrow), and PTA (arrowhead). (B) Left ICA 3D rotational angiography (Towne’s view) shows the AChA (blue dotted line) running to posterior temporal region, and the fetal type PCA (red dotted line). (C) Left ICA angiogram (lateral view) reveals the AChA (arrows) arising from the distal ICA just after the PCOM origin (thick arrow) supplying territory of posterior temporal region, and the PTA variant (open arrow) arising from the cavernous segment of the left ICA terminating in the PICA. (D) Diagrammatic representation of a hyperplastic variant of AChA. A persistent anastomosis between AChA and common stem of temporal branch of PCA. Modified from Takahashi et al.[2] with permission. (E) A schematic illustration of Saltzman type IIIc PTA (arrow). Focal non-fusion of the longitudinal neural artery with the primitive trigeminal artery resulted in the PTA terminating in the PICA. Modified from Ali et al.1 with permission. ICA; internal carotid artery, PCOM; posterior communicating artery, AChA; anterior choroidal artery, PCA; posterior cerebral artery, Unc.Br.; uncal branch of the anterior choroidal artery, Pl.Br; plexal segment of the anterior choroidal artery, Ant.TA; anterior temporal artery of the posterior cerebral artery, Post.TA; posterior temporal artery, MCA; middle cerebral artery, SCA; superior cerebellar artery, BA; basilar artery, AICA; anterior inferior cerebellar artery, PICA; posterior inferior cerebellar artery, VA; vertebral artery, CT; computed tomography, PTA; persistent trigeminal artery.

References

1. Ali S, Radaideh MM, Shaibani A, Russell EJ, Walker MT. Persistent trigeminal artery terminating in the posterior inferior cerebellar artery: case report. Neurosurgery 2008;62:E746–E748.

2. Takahashi S, Suga T, Kawata Y, Sakamoto K. Anteior choroidal artery: angiographic analysis of variations and anomalies. AJNR Am J Neuroradiol 1990;11:719–729.

3. Hahm MH, Moon S. Anomalous hyperplastic anterior choroidal artery and its mimicker: a case series. Surg Radiol Anat 2021;43:1961–1965.

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