STA-MCA吻合術の応用

概要

論文の詳細を見る
It has been latery reported that STA-MCA anastomosis has a protective effet against further cerebrovascular accidents in patients of TIA or RIND. The purpose of this study is to apply STA-MCA anastomosis to non ischemic diseases, namely the application of STA-MCA anastomosis. Surgery of aneurysm has become safe and easy since microsurgery was developed. But IC ophthalmic aneurysm is still difficult to be clipped, especially if the patient has hypo- or aplastic A1. Surgery was performed for these 9 cases to make STA-MCA anastomosis prior to clipping or trapping of the aneurysm or ligation of the internal carotid artery. Vasospasm is one of the most important factors considering about the treatment of SAH. It has been recently known that there is a good correlation between hematoma of the cistern and vasospasm. STA-MCA anastomosis was performed following aneurysmal neck clipping to 11 cases of MCA or IC aneurysm from 3 to 14 days after SAH. Postoperative angiogram revealed dilated STA in 7 cases, which became narrow in follow up angiogram of more than 2 month afterward. There is no perplexed case due to vasospasm. On the other hand there are 135 aneurysms in 129 cases, to which the STA-MCA anastomosis was not performed on clipping surgery. 19 cases (15%) had vasospasm, and 12 cases (9%) remained permanent deficit. STA-MCA anastomosis must have preventive effect of brain ischemia due to vasospasm.