浅側頭動脈-中大脳動脈皮質枝間吻合術における曲型クリップの有用性 : 脳微小血管解剖からの検討

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概要

• 論文の詳細を見る

• A new technique for anastomosis of the superficial temporal-middle cerebral arteries (STA-MCA) is described. It uses a single newly designed angled clip to close the recipient artery during anastomosis.<BR> Fifty two recipient arteries in 10 cerebral hemispheres of cadavers were selected from the perisylvian area by microanatomical survey. Each was at least 10 mm in length and more than 0.8 mm in diameter. Each artery was examined for 1) the external diameter, 2) the number and the diameter of its branches, 3) the number of branches to be cut in anastomosis by using the ordinary two clips or the new single clip, and 4) the territory of the collateral circulation from the central artery as examined by India ink injection study. The average diameter was 1.15±0.1 mm. The arteries had on average five cortical penetrating arteries; 45.3% of the branches were up to 0.2 mm in diameter while those of over 0.4 mm were less than 5.5%. The temporo-occipital artery was largest in diameter, but it had a large number of big branches (13%). By the ordinary method, all branches would have had to be cauterized and cut off. But 77% of the 52 arteries did not need to have any branches cut off during anastomosis when the new method was employed. Collateral circulation from the central artery to the anterior cerebral artery <I>via</I> the cortical lepto-meningeal anastomosis was shown by India ink injection study. Disconnection of the branches by using bipolar coagulation during anastomosis may cause some damage not only to the arterial wall and the brain, but also to such a lepto-meningeal anastomosis. The new single temporary clip method has certain advantages in bypass surgery. The first advantage is preservation of the cortical penetrating arteries and the collateral network, the second is the shortening of the operation time, and the third is the capability of performing anastomosis on the functional area or severe ischemic brain.<BR> Seven clinical cases were operated on using this technique. Only 3 of 24 branches in 7 cortical arteries needed to be cut. The recipient artery was the central artery in 3 cases, the precentral artery in 2 cases and the prefrontal artery in 2 cases. All the cases had uneventful operations and postoperative courses. So it can be said that this is a very simple and useful method in bypass surgery.

• 日本脳神経外科学会の論文
• 1986-06-15

著者

• 湧田 幸雄

  山口大学脳神経外科

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