椎骨動脈瘤に対する直達術・血管内手術における術後中枢性呼吸機能不全についての検討

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Vertebral aneurysm surgery and endovascular procedures carry a potential risk of postoperative respiratory disorders. This is because the respiratory centers, which are located in the reticular formation of the ponto-medullary junction, are supplied by perforators originating from the basilar artery (BA), the vertebral artery (VA) close to the VA union, the proximal posterior inferior cerebellar artery (PICA), and the proximal anterior inferior cerebellar artery (AICA). A retrospective study of 13 patients (7 men and 6 women, mean age 54.5 years, range 21-72 years) surgically treated for vertebral aneurysms during the past 4 years in our hospital was done to determine the relationship between treatment modality and postoperative central respiratory dysfunction. Among our patients, there were 4 saccular aneurysms, 8 dissecting aneurysms and 1 giant fusiform aneurysm; 8 aneurysms were located in the VA between the origin of the PICA and the VA union (including 2 cases whose PICAs were not confirmed by angiography); 4 aneurysms were in the VA-PICA junction; and 1 aneurysm was located in the PICA. Six aneurysms were treated by direct surgery: neck clipping was performed in 3 cases; proximal clipping of the VA at the site distal to the PICA was done in 1 case; trapping was done in 1 case; and trapping with an occipital artery-PICA anastomosis was done in 1 case. Seven aneurysms were treated by endovascular procedure with intraaneurysmal coil embolization. Respiratory arrest occurred in 3 cases whose postoperative course was uneventful. Rerupture and medullary infarction were not confirmed by CT/MRI obtained immediately and a few days after the respiratory arrests. However, more than half of the intra-dural VA was occluded proximally from the VA union after the direct surgical/endovascular procedure, which included proximal clipping for a giant fusiform aneurysm in 1 case and coil embolization for dissecting aneurysms in 2 cases. The periods between surgery and respiratory arrest were 10 hours, 4 days, and 32 days, respectively, for the 3 patients. Voluntary respiration eventually resumed in 2 patients. In the surgical treatment of vertebral aneurysms, the possibility of respiratory complications should be kept in mind even though the early postoperative course may be uneventful. Postoperative respiratory failure can be reversed. Thus prompt diagnosis and treatment under close observation are mandatory, especially in cases with a high risk for postoperative central respiratory dysfunction.
日本脳卒中の外科学会の論文
2003-01-31

椎骨動脈瘤に対する直達術・血管内手術における術後中枢性呼吸機能不全についての検討

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