海綿静脈洞部病変への直達手術—特にC5部のC-C fistulaの治療について

Surgical Approaches to the Cavernous Sinus-Repair of a C-C fistula at the C5 portion of the internal carotid artery.

　海綿静脈洞の常温下での直達手術は，一般には極めて困難で危険とされてきた．しかし，患者を半坐位に保てば，carotid cavernous sinus fistula（以下CCF）を除いて海綿静脈洞の静脈圧を0に近く保つことができ，常温下で洞の開放を行い，洞内の病変の根治的な治療を行うことができる^1,2）．また，CCFの場合でも，頸部内・外頸動脈と頭蓋内内頸動脈のC2 portionの起始部を一時的に遮断すれば上記と同様の方法により海綿静脈洞の直達手術が可能である．この場合，著者は術中の虚血を予防する目的で，約2週間前にEC-IC bypassを行うことにしている．今回は，C5部に生じた外傷性のCCFに対する海綿静脈洞への直達手術について述べる．

It has been generally accepted that the direct ap-proach to the cavernous sinus under the normal temperature is very difficult and dangerous. Bleeding from the cavernous sinus is thought to be very difficult to control. However, when the patient is kept in semi-sitting position during the operation, the venous pressure of the cavernous sinus can he decreased nearly to 0 and the cavernous sinus can be opened without any serious bleeding. Either insertion of Biobond soaked Oxycel or alternative insertion of fibrinogen soaked Gelfoam and thrombin soaked Gelfoam into the opened cavernous sinus is made to control bleeding.