内頚動脈分岐部動脈りゅうの外科治療

概要

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There are some problems in the surgery for the internal carotid artery bifurcation aneurysm (ICB-An). We present 16 cases diagnosed as ICB-An in our institute, and discuss the ICB-An with a review of previous reports. We experienced 16 cases of ICB-An (5 male and 11 female), 1-15 mm in a diameter. Eleven cases presented subarachnoid hemorrhage, and ICB-An was ruptured in 3 of 11. Five cases were all asymptomatic unruptured aneurysm, incidentally diagnosed. Nine of 11 SAH cases and 4 of 5 unruptured aneurysm cases demonstrated multiple aneurysms. We surgically treated 12 cases by direct clipping, and 1 by wrapping. Surgery-related deficits in neurology was not observed in any of the operated cases. In the surgery for the ICB-An, over-retraction of the frontal lobe results in premature rupture, because the aneurysmal dome, which is mostly projected upward at the ICB, adhered to the frontal base. Opening the sylvian fissure is the most important procedure to premature rupture and damage of the perforators form the A1 and M1. Endoscopic assistance is also helpful to confirm the clipping procedure.
一般社団法人日本脳卒中の外科学会の論文