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Brain and Nerve No to Shinkei Volume 30, Issue 6 （June 1978）

Brain and Nerve 脳と神経 30巻6号（1978年6月発行）

Japanese English

原著

頭蓋内内頸動脈分岐部動脈瘤の手術 SURGICAI TREATMENT OF INTERNAL CAROTID BIFURCATION ANEURYSM 児玉南海雄 ¹ , 甲州啓二 ¹ , 鮱名勉 ¹ , 藤原悟 ¹ , 鈴木二郎 ¹ Namio Kodama ¹ , Keiji Koshu ¹ , Tsutomu Ebina ¹ , Satoru Fujiwara ¹ , Jiro Suzuki ¹ ¹東北大学脳研脳神経外科 ¹Division of Neurosurgery, Institute of Brain Diseases, Tohoku University School of Medicine pp.669-675

発行日 1978年6月1日 Published Date 1978/6/1

DOI https://doi.org/10.11477/mf.1406204263

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Abstract 文献概要
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I．はじめに

　頭蓋内内頸動脈分岐部動脈瘤（以下ICB-AN）の直接手術に関しては，教科書的記載も又報告も少なく，意外にその特徴や特異性について検討されていない。

　われわれは，1975年9月までの14年間に嚢状脳動脈瘤直接手術1,000症例を経験したが，うちICB-ANは29例であり，これら症例の外科的治療に関し検討を試み，この部動脈瘤手術の要点について報告する。

Twenty-nine cases of internal carotid bifurcation aneurysm submitted to surgical operations without using microscope were studied.

The operative result is as follows; one dead case during hospitalization (mortality rate 3.4%) and three poor cases (10.2%).

As for the sex and age distributicn of the patients, high incidence on male (three times as many as female) and on the younger generation in the 3rd and 4th decade was noticed.

Characteristic features of these aneurysms are as follows; the aneurysmal wall is thin in one-third of all the cases. Since most of the aneurysms projected to the upper posterior direction, they adhere or penetrate into the brain tissue and often make adhesion with the perforating arteries. As the blood stream from the internal carotid artery runs into the aneurysmal dome straightly, the aneurysms are apt to rupture even by a gentle retraction and/or manipulation of the brain.

Approach from the anterior front direction is most favorable for surgical operation. Aneurysmal neck should be dissected after the temporary clipis put on the parent artery. Since the strong blood flow runs directly against the treated neck of the aneurysm immediately after removing temporary clip, it is advised to use some adhesive agent on the portion to prevent clip or ligature from slipping out.

To prolong the time of temporay occlusion of the parent artery is posssible by means of intra-venous administration of 800 ml of 20% Mannitol. It can be continued for 30 minutes if the temporary clip is put on C₁ portion only, and 10-15 minutes on A₁M₁C₁ portions simultaneously.

High incidence of preoperative and postoperative vasospasm is also remarkable. This should always be taken into consideration whenever surgical treatments of this aneurysm are carried out.