部分血栓化巨大動脈瘤の手術

抄録

Partially thrombosed giant aneurysms are one of the most difficult diseases in neurosurgery. We have had 33 of these cases: 6 in the vertebral artery, 5 in the basilar artery, 8 in the internal carotid artery, 11 in the middle cerebral artery and 3 in the anterior communicating artery. Twenty-three aneurysms were clipped, 2 were removed with anastomosis, the parent artery was clipped in 1 case, 2 cases were treated interventionally and 5 cases were treated conservatively because of serpentine and fusiform types of aneurysms in the internal carotid artery bifurcation, basilar artery or vertebral artery. These conservatively treated patients died due to infarction. When surgery is selected in thrombosed giant aneurysms, an appropriate approach is crucial to secure the neck. Three-dimensional computed tomography angiography was useful to plan the surgical strategy. If the neck is big enough for placement of a clip, arterial reconstruction is the treatment of choice. The reconstruction must include an adequate size of the artery because of the thick wall. If the aneurysm neck is too small to reconstruct, aneurysmectomy with anastomosis is one choice.