未破裂脳底動脈本幹部脳動脈瘤に対してrapid ventricular pacingを用いてクリッピングを行った1例

Clipping of a Large Unruptured Basilar Artery Trunk Large Aneurysm Using Rapid Ventricular Pacing:A Case Report

Ⅰ．はじめに

　脳動脈瘤手術において，母血管確保は重要なステップの1つである．母血管がさまざまな理由で確保できない場合には，低体温下での循環停止⁵⁾やアデノシンによる一時的な心停止¹⁾が行われてきたが，前者は侵襲度と合併症率が高く⁵⁾，後者は心停止が得られる時間のコントロールが難しい¹⁾という欠点がある．近年，それらに代わってrapid ventricular pacing（RVP）が用いられている．今回，脳底動脈本幹部の未破裂脳動脈瘤に対してRVPを用いたクリッピング術を行い，良好な経過を得たので報告する．

　Neck clipping of basilar trunk aneurysms, particularly those of a large size, is challenging because of its location. Here, we report a case of a basilar artery aneurysm successfully treated with neck clipping using rapid ventricular pacing（RVP). A 67-year-old woman was referred to our hospital for treatment of a large basilar artery aneurysm. Although coiling was considered, we performed neck clipping of this aneurysm because of the expected radical therapeutic effect. The patient was positioned in the right park-bench position, and right suboccipital craniotomy was performed. The aneurysm was mainly approached via the right supracerebellar route. RVP softened the aneurysm for easy dissection and insertion of multiple clips. The postoperative course was uneventful, and she was discharged 1 week later without neurological deficits. RVP should be considered for the treatment of complex aneurysms as adjunctive techniques.