52. 内頸動脈-眼動脈分枝部動脈瘤:-特に大型動脈瘤における手術手技-

概要

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Seven cases of large and giant carotid-ophthalmic aneurysms were presented. All the patients underwent intracranial surgery. In 4 cases the neck of the aneurysm was occluded. In other 3 cases gradual occlusion of the internal carotid artery in the neck combined with EC-IC bypass was done. There was one death after clipping the aneurysm because of massive infarction.<BR>Other cases were uneventful or recovered from temporary ischemic symptoms after operation.<BR>Exposure of the carotid artery in the neck and EC-IC bypass are recommended before direct attack. Full exposure of the internal carotid artery from the bifurcation to the origin of the ophthalmic artery is necessary. Ligation of the neck of the aneurysm with thread is a time-consuming and unsuccessful method for treating these aneurysms. In most cases clipping is. successful only after opening or resection of the the dome of the aneurysm. But after opening the dome, unexpectedly long-time, temporary trapping may be necessary to complete the clipping. Mobidity and mortality is mostly related to the ischemic insult during these procedures. Prevention of ischemia and the choice of appropriate clips before opening the dome is necessary. If the clipping is considered dangerous, gradual occlusion of the internal carotid artery with EC-IC, bypass is recommended.
The Japanese Society on Surgery for Cerebral Strokeの論文