開頭クリッピング術とコイル塞栓術による破裂脳動脈瘤の治療成績

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We evaluated treatment results of 109 patients with ruptured cerebral aneurysms when we employed endosaccular coil embolization instead of surgical clipping if sufficient, obliteration rate was predicted. Endosaccular coil embolization was applied to 14 (12.8%) and surgical clipping was used for the other 95 patients. The reasons why endosaccular coil embolization was not indicated were presence of intracranial mass lesions such as intracerebral, intraventricular or subdural hematoma in 15, renal failure in 1, uncertain ruptured site in multiple aneurysms in 13, possibility of dissection in 3, inaccessibility in 2 and inadequate size and configuration in 61. Eighty-three of 109 (76.1%) patients were assessed as modified Rankin scale better than 2 in 3 months. Sufficient obliteration rate such as complete or neck remnant was achieved in 12 of 14 (85.1%) patients treated with endosaccular coil embolization. Occurrence and severity of cerebral vasospasm, secondary hydrocephalus and hospital days were less in patients treated with coil embolization. When endosaccular coil embolization was used to treat ruptured aneurysms if a sufficient obliteration rate was predicted and surgical clipping was employed for others, indication of endosaccular coil embolization was still limited but treatment results were acceptable. Improvement of technique for complete obliteration in endosaccular coil embolization will expand the indication of coil embolization for patients with ruptured cerebral aneurysms, and it may help reduce cerebral vasospasm, secondary hydrocephalus and hospital days.
日本脳卒中の外科学会の論文
2005-03-31

開頭クリッピング術とコイル塞栓術による破裂脳動脈瘤の治療成績

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