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Brain and Nerve No to Shinkei Volume 22, Issue 10 （October 1970）

Brain and Nerve 脳と神経 22巻10号（1970年10月発行）

Japanese English

研究

椎骨動脈・頸動脈吻合術の研究—椎骨動脈閉塞症とある種の椎骨動脈不全に対する手術法の開発 CAROTID-VERTEBRAL ANASTOMOSIS: AN ALTERNATE TECHNIQUE FOR REPAIR OF OBSTRUCTION AND INSUFFICIENCY OF THE VERTEBRAL ARTERY 長島親男 ^1,2 , 上野明 ³ Chikao Nagashima ^1,2 , Akira Ueno ³ ¹東京大学脳神経外科 ²毛呂病院脳神経外科 ³東京大学胸部外科 ¹Department of Neurosurgery, Faculty of Medicine, University of Tokyo ²Moro General Hospital ³Department of Thoracic Surgery, Faculty of Medicine, University of Tokyo pp.1125-1138

発行日 1970年10月1日 Published Date 1970/10/1

DOI https://doi.org/10.11477/mf.1406202789

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Abstract 文献概要
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緒言

　ここに報告する知見は，われわれ脳神経外科医と血管外科医との共同研究の成績の一部である。

　椎骨動脈循環不全の基礎となる病態生理を，一言で表現するとすれば，それは，椎骨動脈の血流量の減少による一過性脳虚血発作であるといえよう。現在までに行なわれている本症に対する手術的療法は，血流量減少をきたしたいろいろな原因に対して，これに対応した方法がとられてきている。

An operative approach suitable in selected cases of vertebral artery insufficiency or vertebral artery obstruction is described. This consisted of freeing of the vertebral artery from the foramen trans-versarium and anastomosis with the carotid artery ether by an autogenous vein bypass grafting or direct end-to-end anastomosis with proximal end of the external carotid artery. The autogenous vein graft taken from the vena saphena magna was anastomosed end-to-end with vertebral artery, while the other end was anastomosed end-to-side with the common carotid artery. This was done in three cases and was beneficial in two cases (case 1 and 3) with 5 and 11 months follow-up.

Case 1 had extensive obstruction of the first and second portion of the right vertebral artery, and had undergone two previous operations in this area,which made dissection and thrombo-endarterotomy difficult. Employing author's (C. N.) technique for freeing the artery from spondylotic compression (J. of Neurosurgery 32: 512-521, 1970), considerable length of patent vertebral artery for transplantation was obtained. Anastomosis was done between the vertebral and the common carotid artery with an autogenous vein grafting.

Case 2 had extensive and severe narrowing of the right vertebral artery from the origin up to around C5 level, which rendered the patch grafting difficult. The common carotid and vertebral anastomosis was accomplished with the same technique as the case 1.

In the third case, the right vertebral artery being larger (6mm in diameter) than the left (2mm) had localized stenosis at it's origin. The left artery, con-genitally smaller in size, had severe kinking and stenosis at C4-5 level. This fact rendered clamping and patch grafting for right vertebral stenosis ex-tremely hazardous. The left vertebral artery was freed and sectioned above the level of kinking of C4 and was anastomosed end-to-end with the ex-ternal carotid artery, attempting to increase the flow through the left. Eleven months follow-up showed satisfactory end result.