総頸動脈不全結紮法による脳動脈瘤の治療

SUBTOTAL COMMON CAROTID LIGATION FOR INTRACRANIAL ANEURYSMS

I．緒言

くも膜下出血はその過半数が脳動脈瘤の破綻によるものであることは周知の通りである

　米国の主要大学の協力によつて進められているCo—operative Study of Intracranial Aneurysms and Sub—arachnoid Hemorrhageの報告によれば5838例のくも膜下出血の中で2951例 （51％）が脳動脈瘤を有し，353例（6.0％）は動静脈奇形を有し，その両者を併せ有するものは40例（0.7％）であつて，脳動脈瘤を有するものの合計は51.7％に達するという。

Subtotal ligation of the common carotid artery was performed on 25 patients with ruptured intracranial aneurysms, including 12 cases with aneurysms of the internal carotid-posterior communicating arteries (Group I ), 5 cases with aneurysms of the middle cerebral arteries (Group II), and 8 cases with aneu-rysms of the anterior cerebral anterior communicat-ing arteries (Group III). Two patients died two days after ligation with overall mortality rate of 8 per cent. No subsequent death followed in the remaining 23 patients during the follow-up period of one to five years. No postoperative complication occurred except in one case who developed coma and hemi-plegia but recovered within a month, although ocu-lomotor palsy which existed before the operation remained with some improvement.

It is noted that no death was encountered in the Group I or aneurysms of the internal carotid-posterior communicating arteries. This corresponds with the results of other authors leading to the conclusion that carotid occlusion, either total or subtotal, is the choice of treatment in the aneurysms of the internal carotid-posterior communicating arteries. However, even with the Group II and the Group III death occurred only in one of each group. This favorable result is in part attributable to the grade of severity of the cases, but also suggests the relative safety of subtotal occlusion of the common carotid artery as a treatment of intracranial aneurysms.

Intracaroticl pressure during and after the surgery was measured on 10 patients, showing gradual ap-proach to the preoperative pressure, but the risk of rupture is not great because of the rapid decline of the frequency of second rupture in the first few months after the initial subarachnoid hemorrhage.