術中脳血管撮影が有用であった巨大内頸動脈瘤の1手術例

概要

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A 62-year-old female was admitted to our hospital with subarachnoid hemorrhage. Cerebral angiography showed a giant saccular aneurysm arising from the inferior wall of the C2-C3 portion of the left carotid artery. We performed radical surgery according to Dolenc's method. The obliteration of the aneurysmal neck was confirmed by inspection and puncture of the aneurysm and Doppler on the aneurysm after neck clipping with two encircled clips and an angled ring clip. The clip was apparently placed adequately over the proximal neck. However, postoperative angiography revealed a slight remnant of the proximal neck of the aneurysm. A second operation was performed, and an encircled clip was added proximal to the previous clips. Intraoperative angiography showed complete obliteration of the aneurysm. It is not so easy to obliterate the proximal neck of the giant aneurysm at the C2-C3 portion of the internal carotid artery because the optic strut inhibits insertion of the clip and the aneurysmal wall is thick, so it is very important to confirm the complete obliteration of the aneurysm. Comfirmation of complete obliteration of the aneurysmal neck is hard to obtain both visually and by puncture of the aneurysm and Doppler in case thrombotic change occurs at the puncture point of the ameurysm. Therefore, use of the intraoperative angiography is very desirable to confirm the safe and complete neck clipping.
日本脳卒中の外科学会の論文
2000-01-31