前脈絡叢動脈瘤のクリッピング術─当院での治療成績と問題点─

概要

論文の詳細を見る
Clipping surgery for an anterior choroidal artery aneurysm (AChAN) is associated with a high risk of ischemic complications, because the anterior choroidal artery (AChA) supplies critical territories, such as the internal capsule. We retrospectively analyzed 40 patients (age range, 34–79 years; mean age, 55.3 years old), comprising 11 males and 29 females, with AChAN who were treated in our institution between 1998 and 2010. Clipping surgery was performed for 24 ruptured and 16 unruptured aneurysms. Aneurysm size ranged from 3 to 12 mm (mean, 5.2 mm). Surgery was performed with higher priority given to the AChA than to the complete neck clipping. None of the patients experienced infarct in the AChA territory. The modified Rankin scale score at discharge was 0–1 in 38 patients (95%). Residual neck, confirmed by postoperative angiography, was identified in 20% of the aneurysms, which is higher than that seen with usual aneurysmal neck clipping. However, none of the patients had rebleeding or regrowth during the follow-up period (mean, 10.6 years; range, 2–14 years).Monitoring with motor evoked potentials, micro-Doppler, indocyanine green videoangiography, and endoscopy may help reduce the risk of ischemic complications.
一般社団法人日本脳卒中の外科学会の論文