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 19, Issue 1 （January 1991）

Neurological Surgery 脳神経外科 19巻1号（1991年1月発行）

Japanese English

研究

海綿静脈洞内動脈瘤の治療成績—直達手術5例の検討 Direct Surgical Management of Aneurysms in the Cavernous Sinus: A report of 5 cases 時村洋 ¹ , 厚地政幸 ¹ , 時村美香 ¹ , 佐藤栄志 ¹ , 轟木耕司 ² , 朝倉哲彦 ² , 福島孝徳 ³ Hiroshi TOKIMURA ¹ , Masayuki ATSUCHI ¹ , Yoshika TOKIMURA ¹ , Eishi SATO ¹ , Koji TODOROKI ² , Tetsuhiko ASAKURA ² , Takanori FUKUSHIMA ³ ¹厚地脳神経外科病院 ²鹿児島大学脳神経外科 ³三井記念病院脳神経外科 ¹Atsuchi Neurosurgical Hospital ²Department of Neurosurgery, University of Kagoshima ³Department of Neurosurgery, Mitsui Mernorial Hospital キーワード： Intracavernous aneurysm , Cavernous sinus , Direct operation , Vein bypass , Primitive trigeminal artery Keyword: Intracavernous aneurysm , Cavernous sinus , Direct operation , Vein bypass , Primitive trigeminal artery pp.15-20

発行日 1991年1月10日 Published Date 1991/1/10

DOI https://doi.org/10.11477/mf.1436900191

PDF(9185KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

I．はじめに

　海綿静脈洞部の病変は，内頸動脈あるいは近接する脳神経との関係，洞よりの出血のコントロールの点から，従来，直達手術が困難とされて来た．しかし1983年，Dolenc^4）によりcombined epi-and subdural approachが考案されて以来，同部の病変に対する直達手術が積極的に行われている．われわれは，昭和63年2月より，7例の海綿静脈洞内動脈瘤を経験し，うち5例に直達手術を行った．代表的な3例を呈示し，若干の文献的考察を加える．

Five patients with aneurysms in the cavernous sinus were treated by direct surgical approach. Two small aneurysms were located in the C3 segment, one small aneurysm was on the primitive trigeminal artery (PTA), and the last two aneurysms were giant ones.The three small aneurysms were discovered incidental-ly by angiography and the two giant aneurysms pre-sented oculomotor palsy.

After ordinary fronto-temporal craniotomy, the two C3 aneurysms were treated through an intradural approach, and the PTA aneurysm and the two giant aneurysms were treated through combined epi- and subdural approach. The three small aneurysms were clipped and the two giant aneurysms were trapped with the reconstruction of ICA by saphenous veins.

In all cases the aneurysms were excluded postoper-atively, but in one giant-aneurysm case (Case 5) the bypass was occluded postoperatively, but the patient had no permanent neurological deficit. The four patients developed third nerve palsy and one developed fourth nerve palsy which resolved with-in 3 to 6 months. In one C3-aneurysm case (case 1) the patient had loss of vision due to much packing in the medial side of the ICA. All patients were discharged and returned to their usual life.

Three cases (case 2, 4, 6) are presented here and the problems of direct surgical management of aneurysms in the cavernous sinus are discussed with the related literature.