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Neurological Surgery No Shinkei Geka Volume 28, Issue 6 （June 2000）

Neurological Surgery 脳神経外科 28巻6号（2000年6月発行）

Japanese English

症例

慢性腎不全患者の未破裂脳動脈瘤に対する瘤内塞栓術—2症例の中期的経過観察結果 Coil Embolization for Incidental Aneurysms in Patients with Chronic Renal Failure : midterm clinical results of two cases 中島利彦 ^1,2 , 加藤貴之 ¹ , 村川孝次 ¹ , 山川春樹 ² , 吉村紳一 ² , 郭泰彦 ² , 坂井昇 ² Toshihiko NAKASHIMA ^1,2 , Takayuki KATOU ¹ , Takatzugu MURAKAWA ¹ , Haruki YAMAKAWA ² , Shinichi YOSHIMURA ² , Yasuhiko KAKU ² , Noboru SAKAI ² ¹高山赤十字病院脳神経外科 ²岐阜大学脳神経外科 ¹Department of Neurosurgery, Takayama Red Cross Hospital ²Department of Neurosurgery, Gifu University School of Medicine キーワード： cerebral aneurysm , renal failure , detachable coil , embolization , endovascular therapy Keyword: cerebral aneurysm , renal failure , detachable coil , embolization , endovascular therapy pp.555-560

発行日 2000年6月10日 Published Date 2000/6/10

DOI https://doi.org/10.11477/mf.1436901906

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Abstract 文献概要
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I．はじめに

　慢性腎不全により透析中の患者は，しばしば脳血管障害を合併するが^11），脳血管障害の診断にMRIやMRAが一般に行われるようになった結果，脳出血や脳梗塞等を発症した透析患者に，偶然未破裂脳動脈瘤が発見される機会が増えてきた．透析患者に開頭術を行うことは，合併症の危険性が高い上^6），虚血性脳血管障害を合併した未破裂脳動脈瘤に対する直達手術は，後遺障害を残す確率が高まるため^2），脳出血や脳梗塞等を合併した透析患者の未破裂脳動脈瘤に対する直達手術には，消極的にならざるを得なかった．しかし脳血管内手術，特にdetachable coilによる瘤内塞栓術が開発された結果，慢性腎不全等の合併症を有する症例に対しても，積極的に治療が行えるようになってきた^9,17）．われわれは，脳出血あるいは脳梗塞を合併した透析患者に，偶然発見された未破裂脳動脈瘤に対し血管内手術を行い，それぞれ4年10カ月，2年6カ月にわたり経過を観察し得たので報告する．

In spite of recent advances in perioperative management, the risk of neurosurgical intervention for pa-tients with chronic renal failure is still considered too high. In this study, coil embolization for incidental aneurysms in such patients is demonstrated in reference to midterm results.

A 42-year-old woman with a history of hemodyalisis for 7 years presented with subcortical hemorrhage in her right frontal lobe. The magnetic resonance angiography (MRA) demonstrated a distal anterior cere-bral artery aneurysm, but it was considered to be unrelated to the hemorrhage. Two and a half months af-ter the hemorrhage the aneurysm was embolized with interlocking detachable coils. Thirty months after embolization, the angiogram revealed the coil compaction and the recanalization of the aneurysm neck. However, 54 months after embolization, the figure of the embolized aneurysm and neck remnant was the same as the previous findings.

A 69-year-old woman with a history of hemodyalisis for 5 years suddenly experienced left hemiparesis. Computed tomography revealed cerebral infarction in the right frontoparietal white matter. In addition, a left middle cerebral artery aneurysm was unexpectedly found on the MRA. Five months after the onset of the attack, the aneurysm was embolized with a Guglielmi detachable coil. An angiogram obtained 24 months after the embolization showed the aneurysm to be almost completely obliterated. In considering the therapeutic risks and benefits for incidental aneurysms of patients with chronic renal failure, intra-vascular surgery could be recommended as a less invasive treatment.