脳動脈瘤手術の工夫 : 安全かつ確実なクリッピングをめざして(<特集>難しい脳動脈瘤の手術の問題点と工夫)

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We evaluated the usefulness of endoscopy, motor evoked potential (MEP) monitoring, and navigation for safe and accurate clipping of cerebral aneurysms. Of 116 patients (ruptured, 50; unruptured, 66) who underwent surgical procedures from January 2000 to September 2005 at our hospital, endoscope-assisted surgery was performed in 50 operations (ruptured, 17; unruptured, 33), MEP monitoring was done in 6 operations (unruptured, 6), and a navigation system was used in 6 operations (ruptured, 1; unruptured, 5). Endoscope-assisted surgery was performed using a 2.7-or 4-mm-diameter endoscope with a tip angle of 30°or 70°. The Stealth Station was used as the navigation system. MEP monitoring was performed using electrical stimulation of the motor cortex and EMG recording of the face, trunk, and the upper and lower extremities contralateral to the stimulated side. During endoscope-assisted surgery, the anatomical relationship between the aneurysm neck and the parent artery or perforating artery could be observed before clipping, and the location of the clip tip, occlusion of the perforating artery, or stenosis of the parent artery could be evaluated after clipping. Among the 28 patients whose perforating artery was observed endoscopically, 3 were re-clipped due to suspicion of perforating artery occlusion or stenosis. On postoperative MR and/or CT images, perforating artery infarctions were observed in 4 patients, although none were symptomatic. Although MEP monitoring was expected to predict the postoperative motor function, fortunately, no patients showed abnormal MEP findings after aneurismal neck clipping. Navigation allowed the prediction of the site of aneurysm and parent artery before dissection, resulting in an accurate approach to these structures. Endoscopy, MEP monitoring, and navigation are considered useful for performing safe and accurate clipping of cerebral aneurysms.
日本脳卒中の外科学会の論文
2007-11-30

脳動脈瘤手術の工夫 : 安全かつ確実なクリッピングをめざして(<特集>難しい脳動脈瘤の手術の問題点と工夫)

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