雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 47, Issue 9 （September 2019）

Neurological Surgery 脳神経外科 47巻9号（2019年9月発行）

Japanese English

研究

血管内治療と開頭クリッピング術を要する多発未破裂脳動脈瘤における治療戦略 Treatment Strategies for Unruptured Multiple Intracranial Aneurysms 福田竜丸 ¹ , 今村博敏 ¹ , 谷正一 ¹ , 足立秀光 ¹ , 福光龍 ¹ , 春原匡 ¹ , 大村佳大 ¹ , 舟越勇介 ¹ , 佐々木夏一 ¹ , 松井雄一 ¹ , 秋山亮 ¹ , 堀内一史 ¹ , 梶浦晋司 ¹ , 重安将志 ¹ , 坂井信幸 ¹ Tatsumaru FUKUDA ¹ , Hirotoshi IMAMURA ¹ , Shoichi TANI ¹ , Hidemitsu ADACHI ¹ , Ryu FUKUMITSU ¹ , Tadashi SUNOHARA ¹ , Yoshihiro OMURA ¹ , Yusuke FUNAKOSHI ¹ , Natsuhi SASAKI ¹ , Yuichi MATSUI ¹ , Ryo AKIYAMA ¹ , Kazufumi HORIUCHI ¹ , Shinji KAJIURA ¹ , Masashi SHIGEYASU ¹ , Nobuyuki SAKAI ¹ ¹神戸市立医療センター中央市民病院脳神経外科 ¹Department of Neurosurgery, Kobe City Medical Center General Hospital キーワード： multiple intracranial aneurysms , clipping , interventional radiology , coiling Keyword: multiple intracranial aneurysms , clipping , interventional radiology , coiling pp.943-947

発行日 2019年9月10日 Published Date 2019/9/10

DOI https://doi.org/10.11477/mf.1436204052

PDF(1151KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　同時に発見された多発未破裂脳動脈瘤に対して，開頭クリッピング術と血管内治療の両方が必要と判断された場合には，抗血小板薬使用の観点から開頭クリッピング術を先行させ，数カ月後に血管内治療を施すのが一般的と考えられる．しかしながら，その治療方針に対する明確な指針は示されていない．

　今回，当施設で多発未破裂脳動脈瘤に対して開頭クリッピング術後に血管内治療を施行した症例を抽出し，その治療成績を検討したので報告する．

　OBJECTIVE:Unruptured aneurysms are often discovered incidentally on MRI. In some patients, multiple aneurysms cannot be treated with only craniotomy or endovascular surgery. When both craniotomy and endovascular surgery are deemed necessary, craniotomy is generally performed first because of the use of antiplatelet agents involved, followed by endovascular surgery several months later. However, no clear criteria for this treatment policy have been elicited. We investigated therapeutic outcomes in patients with aneurysms treated by craniotomy followed by endovascular surgery at our hospital.

　PATIENTS and METHODS:This was a retrospective study including patients undergoing craniotomy clipping of one or more unruptured aneurysms at one site and endovascular surgery for those at a different site, between January 2012 and May 2018 in our hospital. The types of treatment, interval between treatments, complications, and other factors were analyzed.

　RESULTS:This study included 22 patients who underwent a total of 25 craniotomies and 23 endovascular surgeries. The mean time from final craniotomy to initial endovascular surgery was 118 days. Although treatment-related complications occurred in three patients, they were not associated with the time interval between craniotomy and endovascular surgery or the timing of the start of the antiplatelet therapy.

　CONCLUSIONS:The treatment was successful and was carried out safely and appropriately by first performing the craniotomy, followed by a set interval of time before starting the antiplatelet therapy, and then performing the endovascular surgery. Further studies analyzing more cases are required to establish the criteria better, such as the appropriate interval time between treatments.