くも膜下出血で発症した解離性椎骨動脈瘤の手術 : 術中ドップラーが有効であった2例

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To prevent recurrent rupture, proximal occlusion or trapping of the lesion has commonly been advocated for unilateral vertebral dissecting aneurysms that occur with subarachnoid hemorrhage (SAH). Although the results of proximal occlusion were generally excellent, this procedure does not guarantee prevention of rebleeding. Therefore, trapping of the lesion should be considered for the primary treatment of choice to assure its obliteration. However, trapping of vertebral aneurysms may result in postoperative ischemic complications. We describe two cases in which the lesion was successfully trapped using intraoperative Doppler sonography. Both cases presented with SAH and were admitted to our institution on the day of rupture. One case, whose posterior inferior cerebellar artery (PICA) was involved in the aneurysmal wall, was treated by trapping with the PICA involved in the trapped segment. Existence of blood flow in the PICA was confirmed by microprobe using the intraoperative Doppler method. Postoperatively the patient suffered transient mild brainstem ischemia, but eventually recovered completely. The other patient, whose contralateral vertebral artery was smaller than the ipsilateral vertebral artery, was treated by trapping and suffered no postoperative ischemia. Intraoperatively, a test occlusion of the vertebral artery was performed to confirm the safety of permanent occlusion. A microprobe for the Doppler sonography was applied to the lower basilar artery after occluding the lesional dominant vertebral artery, and no significant reduction of the blood flow in the basilar artery was confirmed. The intraoperative Doppler method is not a quantitative technique for measuring blood flow. However, intraoperative test occlusion of the vertebral artery using the microvascular Doppler method or confirmation of the PICA blood flow by the Doppler method may be an important technique in the treatment of selected vertebral dissecting aneurysms.
日本脳卒中の外科学会の論文
2000-05-31

くも膜下出血で発症した解離性椎骨動脈瘤の手術 : 術中ドップラーが有効であった2例

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