未破裂脳動脈瘤クリッピング術の治療成績 : 脳動脈瘤手術初心者の経験

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Recently, endovascular coil embolization is more often used than surgical clipping in the treatment of cerebral aneurysms. However, young neurosurgeons, who have less opportunity to perform and learn surgical clipping than senior surgeons did, must be able to achieve a good outcome when using it. The training in surgical clipping for young neurosurgeons consists of not only knowledge, but also microsurgical skills and experience. A lot of opinions by expert surgeons in surgical clipping are reported, and young neurosurgeons must learn surgical clipping to comprehend them. However, there are no reports from a beginner's point of view on surgical clipping. This paper aims at training in surgical clipping from a beginner's point of view. From 2002 to 2004, among 13 unruptured cerebral aneurysm clipping cases, 14 aneurysms (male 4, female 9 cases), there were 8 middle cerebral artery aneurysms, 3 anterior communicating artery aneurysms and 3 internal carotid artery aneurysms. We analyze operation time, postoperative complications, asymptomatic brain injury and intraoperative rupture. The mean size of the aneurysms and the mean operation time were 5 (4-9) mm and 335 minutes, respectively. There were no postoperative complications, but 3 asymptomatic brain injuries and 2 intraoperative ruptures had occurred. Retrospectively, we know that such surgical complications are avoided by expert neurosurgeons with deep knowledge based on experience. We elucidate the concept of training in surgical clipping for unruptured cerebral aneurysms from the point of view of a beginner learning microsurgery. Beginners, as members of a surgical team, should reflect on every aspect of the surgery to obtain a deep knowledge in surgical clipping.
日本脳卒中の外科学会の論文
2007-09-30

未破裂脳動脈瘤クリッピング術の治療成績 : 脳動脈瘤手術初心者の経験

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