当院における頚部頚動脈瘤に対する治療戦略

抄録

We report the clinical features of six patients who underwent direct surgery at our hospital for large or giant cervical internal carotid artery aneurysms (CICAAs). Three patients underwent aneurysm resection with end-to-end anastomosis of the internal carotid artery (ICA), and three patients underwent proximal occlusion of the ICA. Five patients had good outcomes, including one case with transient dysphagia. In one case, a middle cerebral artery embolization occurred due to ICA occlusion, and the patient died due to extensive cerebral infarction. To avoid ischemic complications in direct surgery for CICAA, preoperative cerebral blood flow assessment and perioperative antithrombotic therapy are indispensable. In addition, to avoid lower cranial nerve palsy during dissection of the aneurysm from surrounding structures, a bloodless surgical field; safe, reliable internal shunt insertion and vascular suture techniques; and an accurate understanding of the anatomy of the neck are also necessary.