Paraclinoid動脈瘤頚部クリッピング術における合併症の分析

抄録

We retrospectively analyzed complications of clipping surgery for paraclinoid aneurysms to establish the art of clipping with a maximum safety. Sixty patients with 63 paraclinoid aneurysms were retrospectively evaluated. The pterional approach was performed in all the patients, and the contralateral approach was applied to 12 aneurysms. Ninety-four clips were used for the 63 aneurysms. Straight or bayonet clips were used in 19 aneurysms; fenestrated clips, in 16; curved or angled clips, in 15; side-curved or side-angled clips, in 8; and L-shaped clips, in 5. The longitudinal clipping was performed for 44 aneurysms; and perpendicular clipping, in 19 aneurysms. The surgical complications included visual impairment in 4 patients (6.7%), temporary oculomotor paresis in 2, CSF leakage in 1, meningitis in 1, and epidural hematoma in 1. Straight or bayonet clips were used perpendicularly in all the 4 patients with visual deterioration. Longitudinal clipping with a non-straight clip is recommended to avoid damage to the optic nerve.