無症候性未破裂脳動脈瘤の手術治療

抄録

In our clinic, we take every opportunity to conduct angiography and we try to find unruptured aneurysms for the purpose of preventing the outbreak of subarachnoid hemorrhage. The authors report the results of surgical treatment for 121 asymptomatic unruptured intracranial aneurysms. Seventy cases were incidental and fifty-one were multiple aneurysm cases which were operated on at a different time from the operation for ruptured aneurysm. There were nine documented postoperative complications (morbidity 7.4%) including seven infarctions, one intracerebral hematoma and one cranial nerve palsy by retraction. There was one death in the series (mortality 0.8%).
If an aneurysm should rupture, the overall therapeutic result will not always become satisfactory even if the operation is conducted by the most skillful surgeon. Therefore, to prevent later rupture, we believe that intact aneurysm should be treated surgically under the following conditions: (1) When the patient has spent a useful and healthy life, even though now being over 70 years of age; (2) There is no uncontrollable systemic complication; (3) There is no ischemic brain disease which must be treated before aneurysm surgery. Moreover attention should be paid to the following points during operation for unruptured aneurysms: (1) identification of perforating artery around the aneurysm is important; (2) do not insist on clipping for every aneurysm; and (3) do not apply the clip over again unless absolutely necessary.