脳動脈瘤術後の再破裂症例の検討

-長期予後調査の結果から-

抄録

Our surgical procedure for ruptured intracranial aneurysms is to dissect not only the neck of the aneurysm but the whole body and then perform aneurysmal neck ligation and clipping by means of temporary occlusion of the parent arteries under administration of brain protective agents (Sendai Cocktail).
From April 1978, to December 1983, 504 cases of ruptured aneurysm (multiplicity 23.8%) had been treated by intracranial direct operation in our clinic. Four-houndred seventy-three cases (thirty-one patients died during hospitalization) were followed up to check the occurrence of rebleeding after surgery. The follow-up period was one to seven years.
Four cases were diagnosed as rebleeding by clinical examination and two of them were confirmed by CT scan. In one case, in which a big ruptured anterior communicating artery aneurysm had been treated by body clipping and muscle wrapping, the same aneurysm rebled sixty-three days after the operation. Slipping out of the clip was thought to be the cause of rebleeding. In another case, where a left middle cerebral artery aneurysm had been treated by neck clipping, rebleeding occurred 138 days after the surgery. The cause could not be determined ever by repeated cerebral angiographies; however the austopsy revealed a very small ruptured right PICA aneurysm.
From this study it is concluded that where aneurysms were treated by our procedures rebleeding did not occur during the follow-up period.