7. ウィリス輪前方の脳動脈瘤に対する coating, proximal ligation および common carotid ligation の長期 follow up

概要

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Recently, the results of neck clipping for intracranial aneurysm have shown great improvement because of the development of techniques and instruments (surgical microscopes, newly designed clips and others). However, it is not rare that a clip cannot be applied to an aneurysm neck in some cases, depending on the shape, the size and the site of the aneurysm.<BR>From 1968 to 1983, we have experienced about 1, 200 cases of intracranial aneurysms at Chiba University and its affiliated Hospitals. The authors have analyzed 63 cases in which a clip was not applied (coating: 46 cases; proximal ligation: 8 cases common carotid ligation: 9 cases). In coating cases, there were five ophthalmic aneurysms, 17 posterior communicating aneurysms, three anterior choroidal aneurysms, eight anterior communicating aneurysms and 16 middle cerebral artery aneurysms. The results were as follows: good recovery in 34, moderate disability in four, severe disability in four, two vegetative cases and six dead by the Glasgow Outcome Scale.<BR>Rebleeding was seen in only one coating case among our series, and this patient died. Thus, the results of proximal ligation and common carotid ligation were favorable.
The Japanese Society on Surgery for Cerebral Strokeの論文