Pterional ApproachによるClipping術後，対側小脳梗塞を来たした2症例

Contralateral Cerebellar Infarction after Aneurysmal Clipping with Pterional Craniotomy : report of two cases

I．はじめに

　開頭術後，開頭術野より離れた部位に出血あるいは梗塞性病変を来たす稀な合併症の報告がある．その中でも特に，テント上の開頭術後に対側小脳に梗塞巣を生じる症例が時にみられる．今回われわれは，pterional approachによる開頭クリッピング術後，対側小脳梗塞を来たした2症例を経験したので，若干の文献的考察を加えて報告する．

A 77-year-old woman underwent right fronto-temporal craniotomy for a right ruptured IC-PC aneurysm(case 1), and a 44-year-old woman underwent right fronto-temporal craniotomy for a right ruptured BA-SCA aneurysm (case 2). They were clipped completely without any troubles during surgery. But postop-erative CT scan demonstrated contralateral cerebellar infarction. We recognized left-hand tremor as aneurological deficit caused by cerebellar infarction in case 1. Concerning the mechanism of contralateralcerebellar infarction after pterional craniotomy, we think that it could be;-1) changing of venous bloodflow by overdrainage of cerebrospinal fluid, 2) destruction of the bridging vein because of cerebral trans-formation with rapid decompression, 3) ischemia caused by brain retraction and compression during opera-tion, 4) hypertension or hypoxia during operation, 5) crossed cerebellar diaschosis, and so on. In our 2 cases, we believe that perioperative CSF overdrainage caused the contralateral cerebellar infarc-tion or CCD. To avoid this kind of infarction, we should try to take more protective and careful proce-dures as well as closer perioperative management.