前交通動脈瘤に対するinterhemispheric approachと穿通枝障害(<特集>前交通動脈動脈瘤の手術手技 : 穿通枝温存)

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To evaluate the characteristics of the perforating artery injury, we reviewed 210 patients with anterior communicating aneurysm who underwent aneurysm clipping through the interhemispheric approach. One hundred fifty-one had ruptured aneurysms, and the other fifty-nine had unruptured ones. Perforating artery injuries occurred in 9 cases (4.3%): 6 (10.2%) in unruptured and 3 (2.0%) in ruptured. Six of 9 cases with perforating artery injury had large aneurysms more than 15 mm in diameter, and the dome of aneurysms adhered to blood vessels such as A2 or perforating artery in 4 cases. Since the anterior communicating aneurysm complex exists in a relatively small space, adhesion between the dome of aneurysms and vessels develops easily. The vascular injury on A2 or perforating artery has occurred during dissecting procedure. Care should be taken to dissect the aneurysm dome from the vessels. In 6 cases, atherosclerotic changes were observed in the neck and/or dome of aneurysms. One of these 6 cases had perforating artery occlusion following aneurysm clipping. Because a clip can easily slip on an aneurysm dome with atherosclerotic changes, clipping may release the atheromatous plaque and occlude the perforating artery. It is important that the aneurysm neck keeps enough space for branching of the vessels following clipping. We also propose a new clip to prevent such slipping on the aneurysm dome. All the vessels, including the perforating artery in the anterior communicating artery complex, can be seen through the interhemispheric approach. However, surgery for large anterior communicating artery aneurysms has a risk of perforating artery injury. It is important to carefully perform dissection and clipping for such aneurysms.
日本脳卒中の外科学会の論文
2002-07-31

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