抄録
Injury to perforating arteries resulting from aneurysm operations was studied using 373 cases with 428 aneurysms. All aneurysms were operated on between 1977 and 1982. Cerebral infarction due to perforator injury was evaluated by pre- and postoperative CT findings. Operation records, cerebral angiography, video and photos taken during operation were also studied. Postoplerative and one year follow ups of neurological signs were also evaluated.
In 428 aneurysms (A. co.: 127, A,: 3, IC-Ophth: 7, IC-PC: 92, IC-Ach.: 30, IC-Bif.: 14, M1: 14, MC: 131, Basilar Bif.: 10), 46 aneursysms (11%) revealed postoperative hypodensity area on the CT due to injury of perforating arteries after the aneurysm operation. IC-Bif. and Basilar Bif. aneurysms had a higher incidence and MC aneurysms had a lower incidence of perforator injury. Concerning aneurysm size, the bigger the aneurysm, the higher the incidence of trouble with the perf orators.
Of the 46 cases showing postoperative hypodensity area, postoperative changes were negative or slight in 33%, but 65% showed moderate to severe motor palsy or consciousness disturbance. After the one year follow up, almost all cases recovered but 22%retained moderate to severe deficits.
Perforator injury was caused mainly by the temporary clipping of the parent artery in 46%of cases. Others were caused by dissection procedure (17%), occlusion due to clipping (15%), sacrifice (7%), injury during aneurysm rupture (7%) and others (8%).
To reduce perforator injury during aneurysm operations, use of a temporary clip should be avoided, sharp dissection should be employed and manipulation of the perforators should be avoided.
