4. 巨大内頸動脈瘤の直達手術不能例に対する治療について

概要

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Eight cases of giant ICA aneurysms were treated by indirect operation. Five cases were treated by CCA ligation (Group I), and three by ICA ligation with STA-MCA anastomosis (Group II). Overall mortality was 12.5% (1/8), and seven patients are living usefully at present. Preoperative enhanced CT findings of these seven aneurysms were divided into two patterns. Pattern A is full enhancement of the aneurysmal cavity (4 cases), and pattern B is partial enhancement of aneurysmal cavity (3 cases). In one case, CT scan could not be performed, because it was before the CT era. We evaluated the effects of surgery by postoperative enhanced CT scan. The postoperative enhancement of aneurysmal cavities was classified into three types. Type I is no change or enlargement of the aneurysmal cavity. Type II is reduction of the aneurysmal cavity. And Type III is no enhancement of the aneurysmal cavity. We considered that Type II and Type III showed the effectiveness of the operation. Two cases of CT pattern A were Type I (no effect of ligation) while only one of CT pattern B was Type I. Based on these results, we concluded that proximal ligation has more effectiveness in cases of CT pattern B (thrombosed giant aneurysm). In total, five aneurysms of these seven cases showed reduction in size or disappearance on CT. The effectiveness of proximal ligation was evaluated precisely in correlation with CT scan.
The Japanese Society on Surgery for Cerebral Strokeの論文