27. 脳動脈瘤手術における脳圧排の方法についての検討

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Self-retaining retractors are indispensable in the modern aneurysm surgery. It is, however, well known that these spatulas sometimes deliver focal ischemic brain damage. Much attention should, therefore, be paid to control the pressure of brain spatula during retraction in order to avoid resultant focal deficit. Ninety-four patients with ruptured aneurysm were closely examined by CT scans pre and postoperatively on the presence of focal ischemic brain damage. In 77 patients out of 94 of the early series of the surgery, the duration of the retraction by a spatula was not restricted and was variable depending on the condition of the brain cortex. In 17 patients of the late series, a brain spatula was applied rep eatedly with a duration of less than 5 minutes with more than 2 minutes intervals. Pre and postoperative CT scans in both series were shown in the following table. Positive CT scan findings indicating focal ischemic damage Early series 14/77 cases (18. 2%) Late series 2/17 cases (11. 8%) There are some reports concerning the relationship between the pressure of brain retractor and the focal brain ischemia. In an experimental work using a rat brain, r-CBF under the brain retractor pressure of 30 mmHg for 30 minutes decreased to 0-40 ml/100 g/min. Another experimental study using an awake monkey demonstrated that r-CBF below 23 ml/100 g/min produced a transient focal paralysis and r-CBF below 18ml/100 g/min generated more profound neurological deficits. The authors supposed that the decrease in r-CBF was caused not only by capillary compression, but also by stasis of the cortical arteries and their penetrating arterioles after cortical compression by a brain spatula and that our results of the surgery with an intermittent brain compression method revealed favorable outcome in the condition of the brain after aneurysm surgery.
The Japanese Society on Surgery for Cerebral Strokeの論文

27. 脳動脈瘤手術における脳圧排の方法についての検討

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