41. 頭蓋内内頸動脈瘤に対する頸部頸動脈クランプの有用性

概要

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Intraoperative premature rupture, as well as when dissection is difficult or when adequate clipping demands a collapsed aneurysm in large or giant aneurysms, temporary arterial occlusion may become necessary. The authors performed cervical carotid clamp in the management of 16 cases of internal carotid aneurysms. The morbidity and mortality of our series are compared between the aneurysms treated with carotid clamp and those without it (20 cases). The criteria of the use of carotid clamp are as follows: 1) intractable hypertension over 200mmHg. 2) acute onset of third nerve palsy with the angiographical evidence of large daughter aneurysm. 3) giant aneurysm. 4) aneurysms situated proximal to the posterior communicating artery and difficult to trap in the intracranial portion. 5) aneurysms of which neck are larger than the diameter of internal carotid artery.<BR>The morbidity (1/16) is not significantly different from that (5/20) of aneurysms treated without carotid clamp. However, neurological, EEG and dynamic CT scan (GBF) changes induced by the preoperative carotid compression should be carefully checked before the use of carotid clamp in the management of difficult internal carotid aneurysms.
The Japanese Society on Surgery for Cerebral Strokeの論文