脳動脈瘤の新しい手術手技―Micro-tourniquet法の開発

Micro-tourniquet Method : A Substitute or Supporting Technique for Aneurysm Clipping

　Ⅰ．はじめに

　従来の脳動脈瘤クリッピング術では，クリップ自身が術野の妨げになったり，クリップをかけた後の血管の可動制限が生じたりすることがある．これらを解決する新しい手技の1つとして，micro-tourniquet法を開発した．

　The micro-tourniquet method is designed as a substitute and/or supporting technique for obliterating aneurysms that are difficult to operate on using the conventional clipping technique. This method is useful for squeezing the aneurysm neck and making a detour around the neck to spare the branching vessels. These micro-tourniquet instruments are a ligature with both ends attached to a ligature guide,a guide holder,a silastic sheath,and a hemostatic clip or a small aneurysm clip set. The ligature is a 20cm long GORE-TEX^(R) suture CV-3,and is attached on both ends to a ligature guide. These ligature guides are made of 7mm wire,and are malleable enough to be bent intentionally during surgery. However,they are also rigid enough to be used as a micro dissector. The silastic sheath is made of a 20G infusion needle,and is cut to a length of 2cm. After branching vessels and perforators are dissected and spared with the aid of the ligature guide,the ligature is passed around the aneurysm neck,both ends of the ligature are passed through the sheath,the aneurysm neck is squeezed,and a clip is applied as a stopper on the ligatures adjacent to the distal end of the sheath. By gently displacing the distal end of the sheath,a conventional aneurysm clip is applied on the aneurysm neck just distal or proximal to the ligature on the neck. Then,the ligature is removed. Two demonstrable cases are presented and the usefulness of the micro-tourniquet method is discussed.