未破裂・無症候性脳動脈瘤の治療 : 手術成績と今後の課題について

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We evaluated neuropsychological function and MR images in patients with asymptomatic cerebral aneurysms in order to improve the results of surgical treatment. Consecutive operations (n=53) on 51 patients since 2000 were included in this study. Direct surgery (DS) was performed in 37 operations on 35 patients, and intravascular surgery (IVS) was performed in 16 operations on 16 patients. IVS was selected for patients with large-sized or posterior circulation aneurysms. MR imaging was conducted 1 week after surgery and WAIS-R examination was done 1 month and 1 year after surgery. In the DS group, abnormal neurological findings were recognized postoperatively in 27% of surgeries. Among them, visual disturbance was permanent in 5% of surgeries, all of which were surgeries for paraclinoid internal carotid artery aneurysms. WAIS-R results deteriorated in 26% of surgeries at 1 month and in 4% of surgeries at 1 year after surgery. MR images at 1 week after surgery revealed brain damage in 38% of surgeries and subdural fluid collection in 18% of surgeries. Of patients with anterior communicating artery aneurysms, 33% showed abnormal neurological findings, 33% showed deterioration of WAIS-R results, although almost all these findings were transient, and 58% showed brain damage upon evaluation of MR images at 1 week after surgery. In the IVS group, abnormal neurological findings were recognized postoperatively in 19% of patients, and hemiparesis was permanent in 6% of patients. Cerebral infarction was observed in 31% of patients on MR images at 1 week after surgery. Of patients with partially thrombosed aneurysms, 75% showed cerebral infarction and 50% showed abnormal neurological findings transiently. To improve surgical results, selection of treatment or surgical approaches should be strictly based on evaluation of postoperative MR images and neuropsychological function, as well as on neurological findings and outcome. Results of DS were not satisfactory in patients with anterior communicating artery or paraclinoid internal carotid artery aneurysms, and results of IVS were discontented in patients with partially thrombosed aneurysms.
日本脳卒中の外科学会の論文
2005-11-30

未破裂・無症候性脳動脈瘤の治療 : 手術成績と今後の課題について

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