前交通動脈瘤手術後の精神症状について

PSYCHIATRIC DISORDERS AFTER SURGERY OF ANTERIOR COMMUNICATING AND INTERNAL CAROTID ANEURYSMS

I．緒言

　頭蓋内動脈瘤の治療成績についての批判検討は，なるべく多くの症例を一定の治療方針のもとに処理して後にはじめて可能なことであろう。この意味で過去10余年の間の脳神経外科医の努力は主として，手術手技の改良と，成績の向上にはらわれ，おびただしい症例の蓄積が行なわれた。この多数の動脈瘤手術症例を綜合的に検討することによつて，動脈瘤の治療は新しい段階に入りつつあるといえる。

　最近長期生存例の遠隔成績と実施した手術手技についての報告も少なくない^1）〜6）。しかしながら最も問題となる術後患者の生活能力，特に精神機能の面での追求に関してはまだ報告も少なく，例を他の脳血管病変たとえば脳出血後の精神症状や大脳病理学的研究と比較すると^7），まだまだ末知の問題が多い。

Fifty seven cases out of 70 cases of intracranial aneurysm were radically operated on by means of clipping, wrapping or intracranial trapping without untoward physical effect from surgery such as hemi-plegia, aphasia or other neurological deficits.

However, 11 cases (20%) showed psychiatric dis-orders temporarily or for a long period of post-operative course, and those were mainly encountered in the aneurysms arising from the anterior com-municating or the anterior cerebral arteries, as fre-quently as in 8 cases (30%) out of 27 cases. The rest 3 cases (9%) were also seen in 33 cases of the aneurysm of the internal carotid or the posterior communicating arteries, among which two were oper-ated by frontal approach and one by subtemporal approach, whereas subtemporal apporach was per-formed in 11 cases of aneurysm. Amnesia, dis-orientation and confabulation were the main features of the postoperative psychiatric disorders, and with other symptoms such as poverty of initiative and erratic attitude they were considered as Korsakoff's syndrome. Those 11 cases, all right handed, receiv-ed various surgical procedures as follows : 7 right frontal, 2 left frontal, 1 bifrontal and 1 right sub-temporal approach. No unusual surgical procedure attributable to the Korsakoff's syndrome was per-formed except for sufficient exposure of the aneu-rysms and involved arteries to obtain a good anato-mical orientation for the radical treatment. Pre-existing spasm of the involved arteries and small lesion in the para-olfactory area of Broca or in the posterior portion of the rectus gyrus were thus considered responsible to producing the postopera-tive Korsakoff's syndrome. A higher incidence was seen in the older age group, especially in the 5 th and 6 th decades, on the contrary the younger age group appeared less vulnerable to the lesions. A follow-up study of the patients was performed and two typical cases were exemplified with the results of psychometry, EEG, angiography and other neuro-logical examination.