57. 椎骨・脳底動脈動脈瘤手術の問題点
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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
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