埋没した脳動脈瘤に対するクリッピングの工夫
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Following neck clipping for encased aneurysm, the dome is sometimes exposed and the clip checked. However, tightening or enwrapping of the perforating branch may occur in some cases, or an appropriate closure line may not be achieved. We have adopted a policy of completely releasing encased aneurysms and observing the aneurysm and surrounding structures in their entirety before neck clipping, and report here on the value of this technique. This study examined 181 aneurysms clipped between January 2008 and October 2011. Of these, a total of 36 aneurysms (19.9%) were encased in the cerebral lobe, comprising 23 ruptured and 13 unruptured aneurysms. The encased aneurysm arose from the middle cerebral artery (MCA) in 21 cases (33.9%), internal carotid-posterior communicating artery (IC-PC) in one (2.6%), anterior communicating artery (A-com) in six (13.0%), and anterior cerebral artery (ACA) in eight (72.7%), with a high frequency of encasement for MCA aneurysms and a high rate in ACA aneurysms. When exposing encased aneurysms, we have adopted the procedure of coagulating and dissecting adhesions of the pia mater and lightly aspirating the gliotic brain, and no complications due to this procedure have been encountered. There have also been no cases of damage to the perforating artery after clipping or incomplete clipping. Although the operations involved in detaching aneurysms from the cerebral lobe are somewhat difficult, it is important to observe aneurysms in their entirety to ensure that neck clipping can be reliably performed.
- 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
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