67. 巨大内頸動脈瘤に対する内頸動脈結紮EC-ICバイパス併用手術における術中血管内圧, 脳表血流量測定の意義

概要

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Seven cases with paraclinoid giant and large internal carotid artery were treated with combined ICA ligation and extracranial-intracranial arterial bypass. By using measurements of cortical blood flow with thermal diffusion method and internal carotid arterial pressure during operation, it was possible to select a patient for abrupt and gradual carotid ligation. All of the grafts were proven patent by angiogram. Also all of the aneurysms were proven thrombosed by angiogram and enhanced computed tomography. Three patients developed transient hemiparesis. One patient developed very mild permanent hemiparesis. Five patients had improvement of pre-existing extra-ocular palsies and visual field defects. Only one patient in whom direct clipping was tried revealed worsening of visual field defect. Trapping procedure was found to increase an ICA stump pressure and thus unnecessary. Prophylactic EC-IC bypass with abrupt or gradual carotid ligation selected by intraoperative cortical blood flow and ICA stump pressure measurement seems to be an effective method of treatment and adjunct to the operation for paraclinoid large and giant aneurysms.
The Japanese Society on Surgery for Cerebral Strokeの論文