血栓化を伴った未破裂巨大脳動脈りゅう 治療困難例の検討:―治療困難例の検討―
スポンサーリンク
概要
- 論文の詳細を見る
Thrombosed giant aneurysm (TGA) possesses a high growth potential. In patients with TGAs, clinical symptoms evolve most commonly from its mass effect. Surgical interventions are therefore required to prevent TGA growth. We analyze the clinical characteristics and histopathological findings of TGAs, and discuss possible mechanisms underlying their growth. We have treated 30 cases of TGA during the last 10 years. Of these, 10 underwent direct surgery and 20 were treated by endovascular surgery. Endovascular obliteration of TGAs frequently fails to terminate their growth when contrast-enhancement of the aneurysmal wall is demonstrated on CT or MRI. Incomplete endovascular obliteration of TGAs does not appear to reduce their growth potential. Complete thrombosis of TGAs, induced either spontaneously or by surgical modification of the blood flow, does not necessarily indicate termination of their growth. The growth of TGAs can be terminated when both the aneurysmal lumen and vascular channels of the aneurysmal wall are physically isolated from the blood flow through direct surgery: neck clipping or trapping. Together with the histopathological findings of TGAs, the above-mentioned characteristics suggest that 2 mechanisms may underlie their growth: intraluminal thrombus accumulation, and proliferation of vascular channels of the aneurysmal wall. Radical surgery to isolate TGAs from the blood flow, before they become too large to be operated on safely, may be advisable.
- 一般社団法人 日本脳卒中の外科学会の論文
一般社団法人 日本脳卒中の外科学会 | 論文
- 頸部内頸動脈のｎｅａｒ ｏｃｃｌｕｓｉｏｎに対するＳＴＡ‐ＭＣＡ吻合術
- 未破裂脳動脈瘤の外科手術の合併症とその対策―慢性硬膜下血腫および後頭蓋窩出血の発生予防―:―慢性硬膜下血腫および後頭蓋窩出血の発生予防―
- 周術期管理指針に基づいたもやもや病に対する血行再建術:―急性期脳血流評価と予防的降圧の効果と限界―
- 未破裂脳動脈瘤クリッピング術の治療成績‐脳動脈瘤手術初心者の経験‐:―脳動脈瘤手術初心者の経験―
- 脳底動脈上小脳動脈分岐部動脈りゅう５８手術例の検討