クモ膜下出血で発症した解離性椎骨動脈瘤の手術—Proximal ClippingとTrappingの比較

Surgical Treatment for Ruptured Dissecting Aneurysms—Proximal clipping vs trapping

I．はじめに

　近年，解離性椎骨動脈瘤（以下VA-DA）によるクモ膜下出血（以下SAH）症例の報告がふえている．VA—DAによるSAH症例では，慢性期に手術を行うべきであるという報告もあるが^14），最近では早期に再破裂し急激な症状の悪化を来すため，やはり早期手術を行うべきであると言う考えが支配的となっている^1,10,11）。これまでのところその手術的治療方法としては椎骨動脈（以下VA）のproximal clippingが広く行われてきたが^{3,5,9,13，14）}，この方法で再破裂した報告もある^1,5,7）．著者らもproximal clipping後再破裂した例を経験しているが，同時にtrappingによりWallenberg症候群を来した例も経験している．今回，自験例を提示し，文献的考察をも加えてこれら両治療法の比較を行う．

The best surgical treatment for ruptured dissecting aneurysms of the vertebral artery is still controversial. Four patients (1 male, 3 female), age ranging from 43 to 62, were operated upon in our department during the last 6 years. Duration from rupture to the operation was 0 to 4 clays. In 2 cases, proximal clipping was the primary treatment, while 2 had a trapping. Antiplatelet agents were given to prevent vasospasm in all cases postoper-atively. In proximal clipping cases, one patient had suf-fered from fatal rerupture on the sixth postoperative clay. In trapping cases, Wallenberg syndrome developed in one patient These results suggest that a proximal clipping may not allow the treatment for the vasospasm because of the danger of rebleeding and also a trapped segment of ver-tebral artery should be as short as possible to avoid coin-promised perforators.