急性期多発性動脈瘤の手術

-6症例の検討-

抄録

The number of our cases with the intracranial aneurysm is 133, of which 17 cases (13%) are multiple intracranial aneurysms-lower percentage compared with approximately 20% reported by other investigators. If intracranial aneurysm which has not passed more than 7 days after the last rupture is defined as an acute stage of ruptured intracranial aneurysm, 6 cases of multiple intracranial aneurysms were operated at an acute stage.
As for acute cases of intracranial aneurysm after subarachnoid hemorrhage, we make it a rule to conduct surgical treatment as soon as possible by diagnosing intracranial aneurysm which is the bleeding source by means of cerebral angiography on the admission day. When there are no neurological focal signs or there are signs suspected of aneurysm in the region of the left internal carotid artery, performed are left carotid angiography and right retrograde brachial angiography. When there are signs suspected of aneurysm in the region of the right internal carotid artery, both right and left carotid angiographies are conducted with the addition. of postoperative vertebral angiography. In all 6 cases all aneurysmal necks were clipped on the same day. The way to approach was as follows; frontolateral incision in the case at unilateral internal carotid artery and the anterior part of the circle of Willis, bilateral frontolateral cranitomies after coronal incision in the case at the bilateral carotid arteries, and atypical coronal incision in the case at the internal carotid artery and the distal part of anterior cerebral artery.
When the preoperative level of consciousness is in coma or semicoma, it is recommended to defer the operation of the non-bleeding aneurysm until the improvement of the consciousness after clipping of the ruptured intracranial aneurysm.
In the case of the operation of the ruptured intracranial aneurysm at an acute stage, the neck clipping of the aneurysm would be impossible without the microsurgical technique since the operative field is extremely limited.
The postoperative results indicated two cases of mental disturbance and one case of hemiparesis. Two patients, having intraventricular hematoma and G-I tract bleeding, respectively, died.