内頚動脈硬膜輪近傍動脈りゅうの手術成績

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We reviewed the surgical outcomes and operative techniques for 42 paraclinoid aneurysms in 40 patients operated between 1995 and 2002. There were 20 ruptured and 22 unruptured aneurysms. Ophthalmic aneurysms were most common (29%), followed by superior hypophyseal (17%), carotid cave (17%), anterior carotid wall (17%) aneurysms, posterior wall aneurysms (12%), lateral wall aneurysms (7%), and genu aneurysms (5%). Thirty-eight aneurysms were clipped satisfactorily, 2 lateral wall aneurysms were wrapped with Vascwrap®, one anterior wall aneurysm was treated by the clipping-on-wrapping method and another large superior ophthalmic aneurysm was treated by trapping and bypass techniques. Using the Glasgow Outcome Scale, surgical outcomes were excellent or good, 81%; fair, 2%; poor, 7%; and death, 10%. Complications directly related to surgical procedures included transient oculomotor nerve palsy, 2; new deficit in vision, 1; cerebrospinal fluid leak, 2; and cerebral infarction, 1. Technical prerequisites for safe surgery included 1) thinning the anterior clinoid process instead of removing it en bloc, 2) using coarse diamond, instead of fine burr, 3) obtaining sufficient mobility of the optic nerve and internal carotid artery by cutting the optic sheath and distal dural ring. Our increased refinements in operative techniques have greatly improved the surgical treatment of paraclinoid aneurysms.
一般社団法人日本脳卒中の外科学会の論文