57. 椎骨・脳底動脈動脈瘤手術の問題点
スポンサーリンク
概要
- 論文の詳細を見る
The therapeutic destinations of 22 aneurysms of vertebrobasilar system were reported. These aneurysms consisted of 15 aneurysms at the distal part of the basilar artery including 1 basilar artery-superior cerebellar artery aneurysm (BAT·An) and 7 vertebral artery-posterior inferior cerebellar artery aneurysms (VP·An). The operability of BAT·Ans was 46.7% due to severity of their preoperative states, of which managements were very difficult, while 100% of VP·Ans were operable. Mostly half of BAT·An resulted in preoperative death, whose possible causes might be the direct damage of brain stem by the first rupture of aneurysms, the secondary damage by vasospasms and the aneurysmal rerupture by sudden changes of intracranial pressure.<BR>Mortalities of our series were very high, ie, 57.1% in BAT·Ans and 14.2% in VP·Ans respectively, because these figures included early cases which were approached subtemporally to BAT·Ans in our series. Several factors which might affect on mortality were abstracted as follows; 1) subtemporal approach, 2) long time application of temporary clips on main trunk, 3) continuous strong retraction of brain, 4) suspected damage of important perforating arteries, 5) coating procedures of aneurysm.<BR>Our surgical experiences of aneurysms at posterior circulation lead us to some principles of operation. Selected approach is transsylvian pterional one to BAT·An and suboccipital lateral route to VP·An. Cautions must be paid not to pull perf orators out of parent arteries when retracting brain, to select microsurgical apparatus with smooth round tip and to choose appropriate clips. It would be better to retract brain intermittently by spatula with narrowed tip.<BR>We often encountered postoperative transient signs of lower cranial nerves, which disturbed recovery of general conditions. So dissection of them around aneurysm has to be treated protectively.
- The Japanese Society on Surgery for Cerebral Strokeの論文
著者
関連論文
- 前頭蓋底悪性腫瘍に対するcombined transbasal and transfacial approachによる一塊切除手術
- 11.集団自律訓練によって気づきを深めた筋緊張性頭痛の1症例について(第11回日本心身医学会近畿地方会演題抄録)
- Ewing肉腫の後頭骨転移による非交通性水頭症の1例
- 眼窩粘液嚢腫
- 石灰化を呈した巨大下垂体腺腫の1例
- 当教室〔関西医科大学脳神経外科学教室〕における入院治療実態の統計的観察--10年間の歩み
- 外傷性脳室内出血 : 22症例の臨床的検討
- 頭皮の血管性腫瘤 : 血管内皮細胞腫1例と cirsoid aneurysm 2例
- 急性硬膜下血腫の予後判定因子ならびにFDP測定の意義
- 前頭蓋底への新しいアプローチ : Extensive Transbasal Approach