Wide neckな無症候性未破裂脳動脈瘤のクリッピング術

抄録

Wide-necked intracranial aneurysms are difficult to obliterate by coil embolization without adjunct techniques. Clipping is still an important technique in the endovascular era. We restrospectively analyzed the characteristics of the clipping techniques of wide-neck intracranial aneurysms. Between April 2008 and October 2010, six wide-necked intracranial aneurysms of 50 asymptomatic unruptured intracranial aneurysms were treated with clipping. One case was an anterior communicating aneurysm, one was a distal anterior cerebral artery aneurysm, one was a middle cerebral artery aneurysm, and three were paraclionoid aneurysms. The maximum diameter of these aneurysms was 20 mm. The average neck diameter was 9.5 mm. There was no neurological morbidity or mortality. The clipping techniques were (1) decompression of the aneurysm with the proximal control, (2) peeling off the aneurysm body from around the structures, (3) using the multiple clipping to prevent the slip-out, (4) clipping in parallel with the parent vessels.
In clipping for wide-necked intracranial aneurysms, these techniques are useful and safe. More outcome studies comparing coil embolization and clipping for wide-necked intracranial aneurysm are required.