解離性脳動脈瘤に対する手術適応と術式(<特集>治療困難な脳卒中に対する挑戦)

概要

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Between 1985 and 2000, we treated 117 patients with acute type cerebral dissecting aneurysms (Mizutani's classification in 1999), including 90 patients with SAH and 27 patients without SAH. Ninty dissecting aneurysms presented with SAH included 75 VA aneurysms, 4 ACA aneurysms, 3 MCA aneurysms, 3 PICA aneurysms, 2 1C aneurysms, 1 SCA aneurysm, 1 BA aneurysm and 1 Pcom A aneurysm. Fifty patients with VA dissecting aneurysms underwent 54 surgeries, comprising 28 proximal clippings, 17 trappings, 5 bleb clippings, 2 proximal clipping with PICA clipping and 2 aneurysm body clippings. Two patients with ACA aneurysm and 1 patient with SCA aneurysm underwent trapping and bypass. Every patient with 1C, MCA and Pcom A dissecting aneurysm underwent wrap and clip. Twenty-seven dissecting aneurysms without SAH comprised 12 VA aneurysms, 4 BA aneurysms, 4 MCA aneurysms, 3 ACA aneurysms, 2 1C aneurysms, and 2 PCA aneurysms. Two patients with ACA aneurysm underwent trapping with bypass, 1 patient with MCA aneurysm underwent wrapping with clip and 1 patient with PCA aneurysm underwent proximal clipping. We discuss the indications and methods of surgery for cerebral dissecting aneurysms with and without SAH based on the outcome of 64 surgical experiences.
2002-11-30