Cerebral Vein Disorders and Postoperative Brain Damage Associated with the Pterional Approach in Aneurysm Surgery
スポンサーリンク
概要
- 論文の詳細を見る
The possible causes of postoperative brain damage were examined in 100 cases of cerebral aneurysms operated on by the pterional approach. Postoperative brain damage occurred in 15% of cases, located mostly in the inferior frontal lobe. Its incidence was higher in early than in delayed operation and increased with severity of preoperative clinical conditions but not correlated with patient age and aneurysm location. The venous perfusion patterns in the inferior frontal lobe were classified into three types based on preoperative venograms: Sylvian type drained mainly into the superficial Sylvian veins (SSVs), Frontal type drained mainly into the frontal bridging veins, and Intermediate type. Postoperative brain damage was most frequent in the Sylvian type with statistical significance (p<0.01). The brain retraction procedure impairs regional cerebral blood flow (rCBF). Venous congestion in the retracted inferior frontal lobe, caused by stretching and narrowing of SSVs due to both brain retraction and dissection of the Sylvian fissure, also reduces rCBF. Thus, a marked reduction in rCBF in the retracted area causes postoperative brain damage. Postoperative venograms showed the SSVs to be obscured in 24% of patients, indicating that the pterional approach possibly influences the SSV perfusion. A venous perfusion disorder during the pterional approach is the most important factor in postoperative brain damage, and careful preoperative assessment of cerebral veins is indispensable.
- 日本脳神経外科学会の論文
- 1992-09-15
著者
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NAKAMURA Hiroshi
Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Science University of Tokyo
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Satoh Akira
Department of Internal Medicine, Cardiovascular Division, Institute of Clinical Medicine, University
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Watanabe Yoshiro
Department of Cardiology, Juntendo University, School of Medicine
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Kobayashi Shigeki
Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
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FUKUDA Kazumasa
Department of Surgery, School of Medicine, Keio University
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Fukuda Kazumasa
Department Of Neurosurgery Chiba Emergency Medical Center
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Kobayashi Shigeki
Department Of Analytical Chemistry Of Medicines Showa Phamaceutical University
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Satoh Akira
Department Of Cardiology Saitama Red Cross Hospital
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KAGEYAMA Yusuke
Department of Neurosurgery, Chiba Emergency Medical Center
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ODAKI Masaru
Department of Neurosurgery, Chiba Emergency Medical Center
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Fukuda Kazumasa
Department Of Applied Biological Science Faculty Of Science And Technology Tokyo University Of Scien
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Odaki Masaru
Department Of Neurosurgery Chiba Emergency Medical Center
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Watanabe Yoshiroh
Department Of Neurosurgery Chiba Emergency Medical Center
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Satoh Akira
Department Of Neurosurgery Chiba Emergency Medical Center
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Kobayashi Shigeki
Department Of Neurosurgery Chiba Emergency Medical Center
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Satoh Akira
Department Of Applied Biochemistry Faculty Of Applied Biological Science Hiroshima University
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Watanabe Yoshiro
Department Of Cardiology Juntendo University School Of Medicine
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Nakamura Hiroshi
Department Of Neurosurgery Chiba Emergency Medical Center
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Nakamura Hiroshi
Department Of Analytical Chemistry Faculty Of Pharmaceutical Sciences Science University Of Tokyo
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Kageyama Yusuke
Department Of Neurosurgery Chiba Emergency Medical Center
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Kageyama Yusuke
Department of Applied Science for Electronics and Materials, Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga, Fukuoka 816-8580, Japan
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