いわゆる後交通動脈動脈瘤の直接手術

ANEURYSM ARISING AT THE JUNCTION OF INTERNAL CAROTID AND POSTERIOR COMMUNICATING ARTERY

I．はじめに

　クモ膜下出血の原因は，脳動脈瘤，あるいは脳動静脈瘻の破裂によるものが大部分であり，それらは脳外科的に処理できるものであることは現代医学の常識となつている。さて，脳動脈瘤の好発部位はWillis動脈輪，特にその前方であり，その中でも前交通動脈および内頸動脈，後交通動脈分枝部が多発部位である、すでに前交通動脈動脈瘤に関しては，発表してあるので^1），今回はいわゆる後交通動脈動脈瘤について，17自験例を中心として述べる（第1表）。この部の動脈瘤に対しては，従来頸部頸動脈の結紮手術によるべきで，直接手術は困難であり，後遺症を残す危険が多いとして，あまり行なわれていなかつた^2）。しかし頭蓋内で安全に脳動脈瘤を処置し得るならばそれにこした方法はなく頚動脈結紮に比しはるかに確実な方法であろう。われわれは脳実質に損傷を与えず，安全に行ない得る接近法で直接手術を行ない，良好な成績をあげているのでこの方法も紹介する。

Clinical and surgical experiences of seventeen cases of aneurysm arising at the junction of internal carotid and posterior communicating artery were reported.

In a case of them the permission of operation could not be obtained and he is healthy now. Two cases died after the entrance into our clinic without operation and were autopsied, in 3 cases the common carotid artery was ligated and cured.

Other eleven cases were clipped or ligated the neck of aneurysm intracranially by our procedure, "Temporal keel form incision", and almost of them were healthy now without mental defficiencies or epileptic episode, except only one who died on the 4 th postoperative day.

It was emphasised that the direct attack for aneurysm in such a place by our approach is more beneficial and safe than the ligation of carotid artery in the neck. In the traditional way, you have to operate through so deep and narrow space with folded skin and muscle flap over the auricle that danger sometimes may happen.

On the other hand, however, if you perform the operation adopting the "Temporal keel form incision", you will find it quite well done using much wider space with folded skin and muscle flap upward and with fully scooped temporal bone.

More-over in this procedure, you can command a complete view of the tentorial notch.