頚部頚動脈瘤に対する外科的治療

Surgical Treatment of Cervical Carotid Artery Aneurysm

Ⅰ．はじめに

　頚部頚動脈瘤は，頭蓋外を含むすべての動脈瘤のうち，1%以下にみられる稀な疾患である⁵⁾．症状，原因，病態は多彩であり，治療は外科手術，血管内治療，薬物療法から症例に応じて治療戦略を選択する必要がある．われわれが経験した頚部頚動脈瘤直達手術を行った9症例の臨床像を検討し，手術適応や方法と留意点について考察する．

　Cervical carotid aneurysms are rare, and surgical treatment should be planned for each patient. The authors report 9 cases of cervical carotid aneurysm in 9 patients（mean age, 53.7 years;5 men）who were treated surgically between 2005 and 2014. The aneurysm was located in the internal carotid artery in 6 patients, the common carotid artery in 2 patients, and the carotid bifurcation in 1 patient. Four aneurysms were recurrences after a previous endovascular intervention（parent artery coil embolization, covered stent placement, or stent with coil embolization). The mean interval between the endovascular therapy and the onset of the present illness was 6 years. All the patients presented a mass effect at the neck, including lower cranial nerve dysfunction in 1 patient. Two patients presented with ischemic events presumably due to thromboembolism from the target aneurysms. Surgical treatments included local vascular reconstruction procedures in 6 patients（interposition vein or artificial graft bypass in 5 patients and in situ bypass in 1 patient). Four aneurysms were then resected. Two patients with rich collateral blood flow were treated with ligation of the parent artery proximal to the aneurysm. Surgical complications included embolic stroke and cranial nerve dysfunction in 2 patients, respectively, both presumably due to surgical manipulation. The modified Rankin scale（mRS）score at discharge was 0 in 5 patients, 1 in 1 patient, 2 in 2 patients, and 6 in 1 patient（vascular tumor). Surgical treatment of cervical carotid aneurysms seems a reasonable treatment of choice, but lower nerve dysfunction and embolism from the aneurysm should be avoided.