38. 脳動脈瘤直達手術における Temporary Clipping の遮断許容時間について

概要

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In our clinic, temporary clip is often applied following Dr. Suzuki's method of preoperative mannitol cover in order to prevent premature rupture and to simplify the surgical procedure. The tolerance time of temporary clipping is discussed in our experience to evaluate its safety.<BR>1) The application of temporary clip in the direct aneurysm surgery was performed in 94 cases among 190 aneurysm cases.<BR>2) The longest tolerance times without new deficit were 46, 32.5, 12.5, 15.7 minutes for Acom, distal AC, IC and MC aneurysms respectively.<BR>3) There were 8 patients with postoperative new dificits. Severe infarction occurred in 2 cases of them with occlusion of 40 and 63 minutes after premature rupture. 5 patients had transient hemiparesis for about one day which were thought to be most likely caused by emboli originating from the aneurysm. In another case with cerebral infarction and incidental aneurysm, hemiparesis, which lasted for a week, occurred after temporary occlusion of 8 minutes.<BR>4) The incidence of the cases with postoperative new deficit was 3.2% and in only 1.2% the occlusion was for less than 20 minutes.
The Japanese Society on Surgery for Cerebral Strokeの論文