内頸動脈瘤に対するRAグラフトの合併症 : その原因と予後

元データ 2007-09-30 日本脳卒中の外科学会

概要

Complex giant or large internal carotid artery aneurysms present a surgical challenge because limitations and difficulty are encountered with either clipping or endovascular treatment. Our review of previous reports suggests that no current vascular assessment can accurately predict the occurrence of ischemic complications after internal carotid artery ligation. The present study concerns surgical technique, complications, and clinical outcome of radial artery grafting followed by parent artery trapping or proximal occlusion for management of these difficult lesions. Between September 1997 and October 2005, we performed radial artery grafting followed immediately by parent artery occlusion in 17 patients with giant or large complex intracranial carotid aneurysms (3 men, 14 women; mean follow-up duration, 62 months). All patients underwent postoperative digital subtraction angiography to assess graft patency and aneurysm obliteration. All 17 aneurysms were excluded from the cerebral circulation, with all radial artery grafts patent. Among 4 patients with cranial nerve disturbances, dysfunction was temporary in 5 ; in the others, oculomotor nerve paresis persisted. No perioperative cerebral infarction occurred. Sensory aphasia reflecting cerebral contusions caused by temporal lobe retraction resolved within 2 months, as did hemiparesis from a postoperative epidural hematoma. With appropriate attention to surgical technique, radial artery grafting followed by acute parent artery occlusion is a safe treatment for complex internal carotid artery aneurysms. Graft patency and aneurysm thrombosis were achieved in all patients. Cranial nerve dysfunction (III, VI) caused by altered blood flow from the internal carotid artery after occlusion was the most common complication and typically was temporary. In our experience with these difficult aneurysms, not only clipping but also reconstruction of the internal carotid artery was required, especially for wide-necked symptomatic cavernous internal carotid artery aneurysms. Radial artery grafting was a reliable way to bypass the parent segment just prior to its occlusion.

著者

寺本 明 日本医科大学 脳神経外科
村井 保夫 日本医科大学 脳神経外科
水成 隆之 日本医科大学千葉北総病院 脳神経センター 脳神経外科
小林 士郎 日本医科大学千葉北総病院脳神経センター
寺本 明 日本医科大学脳神経外科
寺本 明 日医大・脳神経外科
上山 博康 旭川赤十字病院脳神経外科
上山 専康 旭川赤十字病院 脳神経外科
小林 士郎 日本医科大学千葉北総病院 脳神経センター 脳神経外科
小林 士郎 日本医科大学 脳神経外科
水成 隆之 日本医科大学千葉北総病院脳神経外科
水成 隆之 日本医科大学付属千葉北総病院脳神経外科
小林 士郎 日本医科大学千葉北総病院 脳神経センター
寺本 明 日本医科大学
寺本 明 帝京大学ちば総合医療センター 脳神経外科
寺本 明 日本医科大学千葉北総病院 脳神経外科
上山 博康 旭川赤十字病院

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