術中破裂をどう回避し，破裂時にはどう対応するか？

Intraoperative Rupture from Cerebral Aneurysm: Tactics for Management and Strategy for Prevention

Point

・破裂は動脈瘤の剝離の段階で起こることが多い．破裂の際にとるべき吸引管をはじめとした手術器具の配置や操作について学んでおく．

・破裂時には直感的な方法で，自動的に対処ができるようになるのが望ましく，それにはある程度の経験や学習が必要である．

・虚血性合併症の発生を防ぐため，破裂時や破裂予防のための母血管の一時遮断の功罪や遮断時間の目安についてよく理解しておくことが望ましい．

　Rupture of a cerebral aneurysm during surgery carries risks that may lead to poor patient outcomes. Rupture often occurs during the separation procedure of the aneurysm from the surrounding structure. Knowledge regarding the basic principles of operation of surgical apparatus, for example suction devices, before and after the aneurysm rupture event is of paramount importance. It is desirable to deal with these complicated situations automatically in a non-heuristic manner, although some experience and learning are necessary to obtain this ability. When we necessarily apply temporary occlusion of the parent arteries, we need to consider the merits and demerits of temporary occlusion, as well as the limits of the occlusion time in order to prevent ischemic complications.