断裂し脳内に遺残したmicrocatheterを手術摘出した1例

A Case of Surgical Retrieve of Migrated Microcatheter

I．はじめに

　近年，各種microcatheterの開発に伴い，脳神経外科領域における血管内外科手術は飛躍的に進歩した^5）．しかし，その使用に際しては，機材の特性を十分に理解し，操作に習熟することが必要であり，さもなくば重大な合併症を引き起こす可能性がある^2,4,6-9）．microcathe—terの断裂などもその一つであるが，そういった不測の事態に対する対策を事前に考えておくこともまた必要なことであると思われる．

　今回われわれは，頭頂部の脳動静脈奇形に対して超選択的塞栓術を行った際に，断裂し脳内に遺残したmi—crocatheterを手術にて摘出した1例を経験したので，報告する．

This is a report of an accidental breakaway of a mi-crocatheter during endovascular embolization for cere-bral arteriovenous malformation occurring in a 48-year-old female.

She had a sudden onset of cerebral herniated signs caused by a large hemorrhage in the region of the right parietal lobe. An angiogram showed a large arteriove-nous malformation in the same region. 48 days after emergency evacuation of the hematoma and clipping of a feeding artery, we performed endovascular emboliza-tion using a microcatheter as assistant therapy for total removal of the nidus. However, accidentally, the micro-catheter broke and migrated to the distal middle cere-bral artery. Although we tried to retrieve the catheter using a loop snare, we had no success. We eventually retrieved it by open surgery next day. Fortunately the migrated catheter could be seen through a cortical artery, so after trapping it by using elastic thread and cutting off the artery we were able to extract the mi-grated catheter. Finally we were able to remove the nidus totally without other complications.

Since breaking and migration of a microcatheter is a rare but possible accident, we should be prepared to cope with it appropriately.