破裂血豆状内頚動脈前壁動脈瘤に対する急性期high-flow bypass併用動脈瘤trapping術の治療成績

抄録

Background: Blood blister-like aneurysms (BBAs) arising from the anterior wall of the internal carotid artery are characterized by a fragile wall, a poorly defined neck, and a high incidence of rebleeding during the acute period after subarachnoid hemorrhage (SAH). They remain as severe therapeutic challenges. The authors investigated the safety and mid-term efficacy of trapping of the aneurysm with high-flow bypass between the second portion of the middle cerebral and cervical external carotid arteries by using a radial artery graft (EC-RA-M2 bypass) for the complex lesions.
Methods: The medical charts of 14 consecutive patients with ruptured BBAs during the past 4 years were retrospectively reviewed. The patients' mean age was 60.0 years. The World Federation of Neurosurgical Societies grade was I or II in 7 patients and III-V in the other 7 patients. Nine patients underwent acute craniotomy within 24 hours after SAH.
Results: After operation, total elimination of the BBAs with good patency of the bypass was confirmed in all the patients. None of the patients had rebleeding from nor refilling of the aneurysms within a mean follow-up period of 26.5 months. Although one patient showed postoperative perforator area infarction and the other two patients had symptomatic vasospasm, good clinical outcome (Glasgow Outcome Scale: good recovery or mild disability) was observed in 12 patients (89%) at the last follow-up.
Conclusions: Acute surgery using aneurysmal trapping with EC-RA-M2 bypass is effective for the treatment of BBAs, with good and safe mid-term outcomes.