脳神経外科領域における頸部内頸動脈の手術

Neurosurgical Aspect of Carotid Operation in the Neck

I．はじめに

　脳血管性障害を疑つて来院する患者のなかで，その臨床症状および頸動脈写などを詳細に検討すれば，その脳症状が頸部頸動脈の閉塞または狭窄によると思われるものが少なからずあり，一方その手術的治療は欧米においては1954年Eastcott^1）がその成功例を出して以来，症例数も多く日常routineの手術の一つとなつているようである。すなわちRob^2）は典型．的脳卒中発作例の約25％が頭蓋外血管狭窄であつたとし，De Bakey^3）も622例の脳血行不全患者のなかで40％に頭蓋外病変を認めたとしまたGurdjian^4）は脳血管性障害の41％に内頸動脈および推骨動脈に閉塞を認めたとしており，欧米におけるこの種疾患の頻度の多さを示しているが，一方本邦においてはかかる内頸動脈の狭窄性変化に対する手術例の報告はいまだ少なく^5）6）7），本邦における動脈硬化の発現部位が欧米のそれと異なるとはいえ，本邦ではいまだかなりの血管再建術の適応となる症例が見逃がされているのではないかとも考えられる。われわれは臨床上脳血管性障害と診断された症例において詳細に頸部頸動脈の病変を検討し，これが脳症状と密接な関係にあると思われる場合には積極的に種々の血行再建術を行なつてきたので，ここにその手術症例の概要にふれ，同時に内頸動脈の手術に関しての展望を述べる。

This study is based on our experiences of recon-structive operation of 18 carotid arteries in 15 cases which had stenotic changes in the extracranial in-ternal carotid artery.

1) Stenosis of the cervical portion of carotid artery with atheroma plaque. Thromboendarter-ectomy and patch graft angioplasty with teflon were applied to such 4 cases, and the results were satisfactory in 3 cases.

2) Surgical treatments were applied to 5 arteries in 4 cases which had kinking, coiling and tortuosity of the internal carotid artery, and the symptoms were improved in 3 cases of them.

3) There have been some reports indicating that angiospasm may occur in the cerebral or neck ves-sels and cause brain disorder.

Recently, we identified 4 patients as the angio-spasm of the internal carotid artery in the neck.

After surgical treatment using our carotid dilata-tion method, the complaints were improved in parallel with angiographic disappearance of the nar-rowing.

4) Four cases which showed complete occlusion of the internal carotid artery were treated surgically. In one case with acute stroke, thromboenclarterectomy was applied but he died 4 days after operation. For other 3 cases, carotid ligation and excision was performed because the reconstruction of artery was impossible.

If the examination will be performed exactly, more patients, suffering from these disease, will be found and saved by surgical treatment in future in our country.