閉塞性脳血管障害手術例における術後合併症の検討
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EC-IC anastomosis and CEA are now an established procedure for occlusive cerebrovascular diseases. EC-IC anastomosis is generally considered to be a relative low risk for intracranial operative procedure, but its procedure is associated with significant mortality and morbidity.<BR>59 cases of the occlusive cerebrovascular diseases were managed surgically during last 2 years. EC-IC anastomosis in 46 cases (STA-MCA anast. 45, OA-PICA anast. 1) and CEA in 13 cases.<BR>We have experienced postanastomotic complications, such as acute subdural hematoma, intracerebral hematoma, subdural hydroma, angiospasm, occlusion, migrane like headache and skin flap necrosis.<BR>Acute subdural hematoma was complicated in 2 cases, which was recovered from motor weakness completely after the removal of hematoma but the other case remained neurogical deficit. Intracerebral hematoma complicated in 3 cases. First case developed subcortical intracerebral hematoma in the posterior site of the anastomosed region 2 days after operation but was recognized no neurological deficit and was treated conservatively. Second case, which was the progressive stroke, developed the intracerebral hematoma in the temporal L.D.A. of the preoperative CT for 2 weeks after operation. This cases died of DIC on 18 th day after operation following hemorrhagic infarction mentioned above. Third case, which was ICA occlusion, developed the thalamic hemorrhage in 1 year after operation. Subdural hydroma was recognized in cases. This complication was developed no neurological deficits but its course should be observed. Other complications, angiospam in one, occlusion of anastomosed vassels in one, headache after operation in 2 cases and scalp necrosis in 3 cases, were recognized. Postoperative occlusion of ICA after CEA was recognized in one case. In this case, emergency thrombectomy by the Fogarty catheter was carried out.<BR>We reported and discussed postoperative complications of surgical revascularization for occlusive cerebrovascular diseases.
- The Japanese Society on Surgery for Cerebral Strokeの論文
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