56. 全摘出困難な脳動静脈奇形 (AVM) に対する feeder clipping について

概要

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Six out of 80 cases of intracranial arteriovenous malformation (AVM) were operated on by clipping of the feeding artery (feeder clipping) during the years from 1978 to 1983. Two patients were operated on by two-staged feeder clipping, two were treated by embolization and feeder clipping, and the rest were feeder clipping and staged excision. The size of the AVM and the flow of the A-V shunt were decreased in all cases. In this series, the authors considered the indications of feeder clipping of AVM are as follows; 1. huge or deep unresectable AVM 2. clinical pictures 1) mass effect 2) progressing stroke by the steal phenomenon 3. high flow of the A-V shunt Feeder clipping, however, involves some problems such as confirmation of the feeder during the operation, a rapid change of hemodynamics or normal perfusion pressure breakthrough and longterm follow up. The authors have coped with difficulties in performing angiography during the operation, in maintaining the systemic hypotension during and after the operation, in measuring the regional cerebral blood flow and in proceeding with the embolization or staged operation. The authors confirmed that feeder clipping of AVM is not ideal, but of supplementary value in some cases.
The Japanese Society on Surgery for Cerebral Strokeの論文