傍前床突起部内頚動脈瘤に対する直達術─手術手技と治療成績─

抄録

Paraclinoid aneurysms can be defined as intracranial aneurysms arising from the internal carotid artery, between the distal dural ring and the posterior communicating artery. They include carotid-ophthalmic artery aneurysms, carotid-superior hypophyseal artery aneurysms, carotid cave aneurysms, etc. Paraclinoid aneurysms are considered as one of the most suitable lesions for endovascular treatment. However, surgical treatment is often necessary in cases with wide-neck and/or large aneurysms. When surgical clipping is performed for such aneurysms, the following skull-base techniques are considered in accordance with particular aneurysmal characteristics: extradural, intradural, and partial anterior clinoidectomy; opening the distal dural ring; and control of bleeding from the cavernous sinus. In the present report, we describe our experience with and the clinical outcome of paraclinoid aneurysms treated surgically. Twenty-three consecutive patients who underwent surgical neck clipping between January 1, 2010 and March 31, 2016, were included in this study. Three out of 23 patients presented with subarachnoid hemorrhage, and four had visual disturbances. The aneurysms of 16 patients were identified incidentally. Complete exclusion was confirmed in all patients on follow-up angiography. New visual complications were not detected in patients who had no preoperative ophthalmological symptoms. On the other hand, out of the four patients who had visual disturbances before surgery, one experienced improved symptoms, two indicated no change, while the visual acuity of one patient deteriorated to blindness. The present study shows that surgical clipping is still one of the therapeutic options in most cases of paraclinoid aneurysms. Basic skull base technique is an indispensable factor for successful clinical results.