脳動脈瘤クリッピング術における穿通枝温存の工夫─ポリグラクチンメッシュの有用性─

抄録

Adequate operative field and preservation of perforating arteries is necessary for successful, safe clipping of cerebral aneurysm. However, it is often difficult to avoid multiple perforators adjacent or dorsal to the aneurysm even if they could be separated from the aneurysm. Here, we used a polyglactin mesh (Vicryl mesh®) for aneurysmal clipping surgery. The polyglactin mesh is made of glycolic-lactic acid polyester and can be hydrolyzed within a living body. It is very thin, about 0.1 mm, without being fuzzy, and can be cut freely into any size and shape. Because of its consistency, it can hold dissected perforators off the aneurysm while clipping the neck, thus facilitating safe and successful maneuvers. It can also be retrieved safely and easily because it does not adhere to the surrounding structures. We used them in 45 cases of aneurysm. We could clip the cerebral aneurysms safely while avoiding perforators, other critical arteries, and cranial nerves around the aneurysm. No complications like vasospasm and perforator injuries were noted. Eighty-seven percent of the clipping procedures were accomplished by junior neurosurgeons under the guidance of senior instructors using the polyglactin mesh. This procedure is useful and safe in preserving critical arteries and structures like perforators and cranial nerves around the cerebral aneurysm.