頭蓋内動脈瘤を伴う内頸動脈狭窄症に対する外科的治療 : その適応と考察

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Surgical treatment of the symptomatic carotid stenosis associated with ipsilateral intracranial aneurysm requires special strategic consideration. A 56-year-old housewife was admitted to a local hospital with a history of mild hypertension and recent episodes of recurrent transient ischemic at-tacks of the right cerebral hemisphere. Carotid angiography revealed bilateral stenosis of the carotid artery, 90% stenosis with ulcer on the right and 50% smooth surfaced stenosis on the left, middle cerebral trifurcation aneurysm on the right, internal carotid aneurysm in the left cavernous portion, and aplasia of the left anterior cerebral artery at its horizontal portion. She was referred for surgery. Neurological examination revealed a slightly disturbed mentality. During hospitalization she developed left hemiparesis and computerized tomography scan demonstrated right frontal watersh-ed infarction. One month after the onset of cerebral infarction, operative treatment was attempted with special care to prevent lowering systolic blood pressure during procedure. The right middle cerebral artery aneurysm was first clipped, and right carotid endarterectomy was performed, while mannitol and barbiturate were administered without resort to internal shunt. Postoperatively the left hemiparesis improved gradually. Twenty-seven cases of the carotid stenosis associated with intracranial aneurysm(s) were col-lected from the literature and the strategic problems of these cases are discussed.
日本脳神経外科学会の論文
1984-10-15

頭蓋内動脈瘤を伴う内頸動脈狭窄症に対する外科的治療 : その適応と考察

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