脳底動脈遠位部broad neck動脈瘤に対する意図的な頸部形成的不完全clippingを併用した塞栓術

Intentional Neck-plastic Incomplete Clipping Followed by Coil Embolization for Broad-necked Distal BA Aneurysms

I．はじめに

　外科手術，塞栓術いずれでも単独では治療困難な動脈瘤に対しては，これらを組み合わせた治療法が1つのオプションとなる．Broad neckを有する脳底動脈瘤に対し，頸部を形成するような“意図的な”不完全clippingを行った後に塞栓術を行い，良好な結果を得た3症例を報告する．

Objective: We report three patients with broad-necked distal basilar artery (BA) aneurysms treated withintentional incomplete clipping followed by endovascular occlusion using Guglielmi detachable coils.

Methods: The location of the aneurysms was BA bifurcation in one patient and BA-superior cerebellarartery (SCA) in two. One patient presented with acute subarachnoid hemorrhage and two patients had in-cidental aneurysms. In two patients, endovascular treatment was thought to be difficult considering themorphology of the aneurysms and surgical treatment was performed as the first choice of treatment. Onepatient with a BA-SCA aneurysm underwent enclovascular treatment using a remodelling technique first.However, it was impossible to place the coil preserving SCA, so surgical treatment was performed. In allpatients, the attempt to pursue complete clipping was considered to be accompanied with high risks ofmorbidity, so neck-plastic incomplete clipping was performed intentionally. One to six days after thesurgery, coil embolization was performed.

Results: In all patients, complete occlusion of the aneurysms was achieved and all patients had excellentclinical outcomes.

Conclusion: Intentional neck-plastic incomplete clipping followed by endovascular coiling may be a usefultreatment option for patients with broad-necked distal BA aneurysms.