頸部交感神経切除術により治癒した脳動脈瘤術後脳血管攣縮の1例

CEREBRAL ANGIOSPASM RELEASED WITH CERVICAL SYMPATHECTOMY

Ｉ．はじめに

　脳動脈瘤の破裂によるくも膜下出血に伴って起こる脳動脈攣縮は，よく遭遇する事件であるが，そのいたずらにより臨床症状は大きく修飾され，予後に重篤な影響を及ぼすもので，これは脳動脈瘤治療に当り，悩まされる大きな問題の一つである。この脳動脈攣縮の発生機序及びその治療方法については，徐々に解明されつつあるが決定打の出るに至っていない現状である^{1）2）3）6）7）8）16）17）}。

　我々は前交通動脈瘤の柄部結紮術後に発生した脳動脈瘤攣縮による運動麻痺，akinetic mutismを星状神経節遮断，つづいて行なった上頸部交感神経節切除術及び頸部頸動脈周囲交感神経剥離術により治療せしめ得た症例を経験したので，その症例の経過を報告し，術後脳動脈攣縮とその治療について考察した。

Abstract

A case with cerebral angiospasm was reported, which occurred after radical operation of aneurysm of anterior communicating artery and was released with cervical sympathectomy.

The patient, 50-year-old female, was radically operated on the 5 th day after rupture of aneurysm. Five days elapsed without events after the opera-tion, but right hemiparesis, paraparesis, and akinetic mutism developed on the sixth day. Left carotid angiogram revealed disappearance of aneurysm and severe diffuse angiospasm of bilateral anterior and left middle cerebral arteries, which was thought to be responsible for the neurological deficits.

To release the angiospasm and to prevent cir-culatory disturbances and brain edema secondary to angiospasm, vasodilators administratian, stellate ganglion block, low molecular dextran drip and steroid administration were boldly carried out with-out worrying about rerupture of aneurysm. Except for stellate ganglion block no effects were obtained. Transient effect with stellate ganglion block made us perform superior cervical ganglionectomy and periarterial denervation of cervical carotids. Just after cervical sympathectomy the symptoms and signs were getting improved hour after hour. Twenty-four hours later she got alert and three weeks later the neurological deficits disappeared. The left carotid angiograms after the sympa-thectomy showed improvement of angiospasm.

According to newer data, it is proved that there is a functional adrenergic innervation to cerebral vessels. This may warrant the effectiveness of cerebrovascular denervation with cervical sympa-thectomy to release some of cerebral angiospasm.