後下小脳動脈を含んだ出血発症解離性動脈瘤に対する浅側頭動脈移植を用いた血行再建術

後下小脳動脈(PICA)を含んだ脳動脈瘤の治療の際には, PICAの血行再建が必要となる2)5)11)12). 筆者らは, 浅側頭動脈(STA)をinterposed graftとして用いたPICAの血行再建術を1995年に始めてから今日までに12症例に対して施行した6). このうち, PICAを含んだ出血発症解離性動脈瘤7症例に対する同法の有用性について報告する. 対象 症例は, PICAの血行再建が必要であったくも膜下出血発症の椎骨動脈解離性動脈瘤5例と後下小脳動脈解離性動脈瘤2例である. 男性2例, 女性5例, 平均年齢は46歳(32-63歳)であった. 入院時のHunt and Kos...

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Published in脳卒中の外科 Vol. 33; no. 6; pp. 398 - 401
Main Authors 甲斐, 豊, 濱田, 潤一郎, 倉津, 純一, 戸高, 健臣, 黒田, 順一郎, 矢野, 茂敏, 森岡, 基浩, 水野, 隆正
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本脳卒中の外科学会 30.11.2005
日本脳卒中の外科学会
Subjects
Online AccessGet full text
ISSN0914-5508
1880-4683
DOI10.2335/scs.33.398

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Abstract 後下小脳動脈(PICA)を含んだ脳動脈瘤の治療の際には, PICAの血行再建が必要となる2)5)11)12). 筆者らは, 浅側頭動脈(STA)をinterposed graftとして用いたPICAの血行再建術を1995年に始めてから今日までに12症例に対して施行した6). このうち, PICAを含んだ出血発症解離性動脈瘤7症例に対する同法の有用性について報告する. 対象 症例は, PICAの血行再建が必要であったくも膜下出血発症の椎骨動脈解離性動脈瘤5例と後下小脳動脈解離性動脈瘤2例である. 男性2例, 女性5例, 平均年齢は46歳(32-63歳)であった. 入院時のHunt and KosnikのgradeはIIが4例で, IIIが3例であった. 初期の2例は慢性期に, その後の5例は発症72時間以内の急性期に手術を行った(Table 1). 手術手技 手術は側臥位で後頭下開頭を行い, 解離性動脈瘤の観察を十分に行ったのちにSTAの頭頂枝を約5cm採取する. 解離性動脈瘤の解離部をクリップでtrapする. PICAの近位端を切断し, PICAの近位部に十分な可動性が得られれば, end-to-endに, 十分な可動性が得られなければ, end-to-sideにSTAの遠位端とPICAを10-0ナイロン糸で間歇的吻合を行う. いずれの場合でもSTAの近位端は可能な限り硬膜内椎骨動脈と9-0ナイロン糸でend-to-sideに間歇的吻合を行う.
AbstractList In patients with ruptured dissecting aneurysms requiring occlusion of the posterior inferior cerebellar artery (PICA), revascularization of this artery should be performed. We present a novel technique for revascularization of the PICA. After a segment of the superficial temporal artery (STA) was harvested, the aneurysm was treated by trapping followed by placement of a vertebral artery-PICA bypass using the STA as an interposed graft. When the length of the proximal PICA was inadequate, the distal end of the STA was anastomosed to the proximal PICA in an end-to-side fashion. When the length of the proximal PICA was adequate, the STA was anastomosed to the proximal PICA in an end-to-end fashion. In either case, the proximal end of the STA was anastomosed to the vertebral artery in an end-to-side fashion. This procedure was used in 7 patients whose dissecting aneurysms involved the PICA. Although 1 patient developed partial laterally medullary syndrome, follow-up evaluation revealed graft patency in all patients. Although our procedure requires harvesting of a STA graft and 2 anastomoses, it facilitates anterograde flow to the PICA territory. It also involves minimal mobilization of brain stem perforators and the proximal PICA.
後下小脳動脈(PICA)を含んだ脳動脈瘤の治療の際には, PICAの血行再建が必要となる2)5)11)12). 筆者らは, 浅側頭動脈(STA)をinterposed graftとして用いたPICAの血行再建術を1995年に始めてから今日までに12症例に対して施行した6). このうち, PICAを含んだ出血発症解離性動脈瘤7症例に対する同法の有用性について報告する. 対象 症例は, PICAの血行再建が必要であったくも膜下出血発症の椎骨動脈解離性動脈瘤5例と後下小脳動脈解離性動脈瘤2例である. 男性2例, 女性5例, 平均年齢は46歳(32-63歳)であった. 入院時のHunt and KosnikのgradeはIIが4例で, IIIが3例であった. 初期の2例は慢性期に, その後の5例は発症72時間以内の急性期に手術を行った(Table 1). 手術手技 手術は側臥位で後頭下開頭を行い, 解離性動脈瘤の観察を十分に行ったのちにSTAの頭頂枝を約5cm採取する. 解離性動脈瘤の解離部をクリップでtrapする. PICAの近位端を切断し, PICAの近位部に十分な可動性が得られれば, end-to-endに, 十分な可動性が得られなければ, end-to-sideにSTAの遠位端とPICAを10-0ナイロン糸で間歇的吻合を行う. いずれの場合でもSTAの近位端は可能な限り硬膜内椎骨動脈と9-0ナイロン糸でend-to-sideに間歇的吻合を行う.
Author 戸高, 健臣
倉津, 純一
濱田, 潤一郎
甲斐, 豊
黒田, 順一郎
森岡, 基浩
水野, 隆正
矢野, 茂敏
Author_FL HAMADA Jun-ichiro
MIZUNO Takamasa
TODAKA Tatemi
YANO Shigetoshi
KURODA Jun-ichiro
KAI Yutaka
KURATSU Jun-ichi
MORIOKA Motohiro
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熊本大学脳神経外科
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DocumentTitleAlternate Vertebral Artery-Posterior Inferior Cerebellar Artery (PICA) Bypass Using a Superficial Temporal Artery Graft to Treat the Ruptured Dissecting Aneurysms Involving the PICA
DocumentTitle_FL Vertebral Artery-Posterior Inferior Cerebellar Artery (PICA) Bypass Using a Superficial Temporal Artery Graft to Treat the Ruptured Dissecting Aneurysms Involving the PICA
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References 2) Berger MS, Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61: 882-896, 1984
8) Marano SR, Fischer DW, Gaines C, et al: Anatomical study of the superficial temporal artery. Neurosurgery 16: 786-790, 1985
1) Ausman JI, Diaz FG, Mullan S, et al: Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73: 462-465, 1990
9) Shrontz C, Dujovny M, Ausman JI, et al: Surgical anatomy of the arteries of the posterior fossa. J Neurosurg 65: 540-544, 1986
11) Yamada K, Hayakawa T, Ushio Y, et al: Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome. Neurosurgery 15: 834-838, 1984
6) Hamada JI, Nagahiro S, Mimata C, et al: Reconstruction of the posterior cerebellar artery in the treatment of giant aneurysms. Report of two cases. J Neurosurg 85: 496-499, 1996
7) Lee KS, Gower DJ, Branch CL, et al: Surgical repair of aneurysms of the posterior inferior cerebellar artery? a clinical series. Surg Neurol 31: 85-91, 1989
3) Chater N: Microsurgical vascular bypass for occlusive cerebrovascular disease, in Rand RW (ed): Microneurosurgery, 2nd ed. St Louis, Mosby, 1978, pp363-378
5) Friedman AH, Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60: 325-334, 1984
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4) Durward QJ: Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82: 137-139, 1995
References_xml – reference: 2) Berger MS, Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61: 882-896, 1984
– reference: 11) Yamada K, Hayakawa T, Ushio Y, et al: Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome. Neurosurgery 15: 834-838, 1984
– reference: 7) Lee KS, Gower DJ, Branch CL, et al: Surgical repair of aneurysms of the posterior inferior cerebellar artery? a clinical series. Surg Neurol 31: 85-91, 1989
– reference: 8) Marano SR, Fischer DW, Gaines C, et al: Anatomical study of the superficial temporal artery. Neurosurgery 16: 786-790, 1985
– reference: 4) Durward QJ: Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82: 137-139, 1995
– reference: 6) Hamada JI, Nagahiro S, Mimata C, et al: Reconstruction of the posterior cerebellar artery in the treatment of giant aneurysms. Report of two cases. J Neurosurg 85: 496-499, 1996
– reference: 12) Yamaura A, Watanabe Y, Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72: 183-188, 1990
– reference: 5) Friedman AH, Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60: 325-334, 1984
– reference: 1) Ausman JI, Diaz FG, Mullan S, et al: Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73: 462-465, 1990
– reference: 3) Chater N: Microsurgical vascular bypass for occlusive cerebrovascular disease, in Rand RW (ed): Microneurosurgery, 2nd ed. St Louis, Mosby, 1978, pp363-378
– reference: 10) Sundt TM Jr, Piepgras DG: Occipital to posterior inferior cerebellar artery bypass surgery. J Neurosurg 48: 916-928, 1978
– reference: 9) Shrontz C, Dujovny M, Ausman JI, et al: Surgical anatomy of the arteries of the posterior fossa. J Neurosurg 65: 540-544, 1986
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Snippet 後下小脳動脈(PICA)を含んだ脳動脈瘤の治療の際には, PICAの血行再建が必要となる2)5)11)12). 筆者らは, 浅側頭動脈(STA)をinterposed graftとして用いたPICAの血行再建...
In patients with ruptured dissecting aneurysms requiring occlusion of the posterior inferior cerebellar artery (PICA), revascularization of this artery should...
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SubjectTerms dissecting aneurysm
posterior inferior cerebellar artery
reconstruction
superficial temporal artery
Title 後下小脳動脈を含んだ出血発症解離性動脈瘤に対する浅側頭動脈移植を用いた血行再建術
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