脳動脈瘤治療における補助的血管内または外科治療の有用性
「はじめに」近年, 脳動脈瘤に対する治療法は開頭クリッピング術と血管内治療とが併存しており6)16)17), 治療現場ではそれぞれの治療法の長所短所を考慮して治療選択を行うことが必要となっている. しかしながら動脈瘤の形態によってはどちらかの単一治療法では治療困難な症例が存在する. 広頸で紡錘状の動脈瘤に対しては十分な瘤内コイル塞栓術は困難であるし7)17), 解剖的に到達困難な部位の動脈瘤に対する外科的直達術は新たな神経症状を合併させる危険を伴っている3)9)10). 昨今, 開頭術と血管内治療を補助的に組み合わせることにより単一手技では治療困難な動脈瘤に対しての治療可能性が期待されている1...
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| Published in | 脳卒中の外科 Vol. 36; no. 1; pp. 7 - 11 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2008
日本脳卒中の外科学会 |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.36.7 |
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| Abstract | 「はじめに」近年, 脳動脈瘤に対する治療法は開頭クリッピング術と血管内治療とが併存しており6)16)17), 治療現場ではそれぞれの治療法の長所短所を考慮して治療選択を行うことが必要となっている. しかしながら動脈瘤の形態によってはどちらかの単一治療法では治療困難な症例が存在する. 広頸で紡錘状の動脈瘤に対しては十分な瘤内コイル塞栓術は困難であるし7)17), 解剖的に到達困難な部位の動脈瘤に対する外科的直達術は新たな神経症状を合併させる危険を伴っている3)9)10). 昨今, 開頭術と血管内治療を補助的に組み合わせることにより単一手技では治療困難な動脈瘤に対しての治療可能性が期待されている1)7)10-12)20). 今回自験例において開頭術と血管内治療とが組み合わされた症例の現状を提示しその可能性を検討した. 「症例と方法」1997年5月から2005年12月までに血管内治療の行われた症例は破裂86例(86瘤), 未破裂99例(112瘤), 合計198瘤であった. |
|---|---|
| AbstractList | 「はじめに」近年, 脳動脈瘤に対する治療法は開頭クリッピング術と血管内治療とが併存しており6)16)17), 治療現場ではそれぞれの治療法の長所短所を考慮して治療選択を行うことが必要となっている. しかしながら動脈瘤の形態によってはどちらかの単一治療法では治療困難な症例が存在する. 広頸で紡錘状の動脈瘤に対しては十分な瘤内コイル塞栓術は困難であるし7)17), 解剖的に到達困難な部位の動脈瘤に対する外科的直達術は新たな神経症状を合併させる危険を伴っている3)9)10). 昨今, 開頭術と血管内治療を補助的に組み合わせることにより単一手技では治療困難な動脈瘤に対しての治療可能性が期待されている1)7)10-12)20). 今回自験例において開頭術と血管内治療とが組み合わされた症例の現状を提示しその可能性を検討した. 「症例と方法」1997年5月から2005年12月までに血管内治療の行われた症例は破裂86例(86瘤), 未破裂99例(112瘤), 合計198瘤であった. |
| Author | 鈴木, 宰 種井, 隆文 加藤, 丈典 渡辺, 正男 若林, 健一 井上, 憲夫 福井, 一裕 |
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| References | 10) Lawton MT, Hinojosa AQ, Sanai N, et al: Combined microsurgical and endovascular management of complex intracranial aneurysms. Neurosurgery 52: 263-275, 2003 3) Day AL: Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72 (5) : 677-691, 1990 6) Henkes H, Fischer S, Weber W, et al: Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54 (2) : 268-280; discussion 280-265, 2004 11) Lot G, Houdart E, Cophignon J, et al: Combined management of intracranial aneurysms by surgical and endovascular treatment. Modalities and results from a series of 395 cases. Acta Neurochir (Wien) 141: 557-562, 1999 14) Massoud TF, Guglielmi G, Vinuela F, et al: Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR Am J Neuroradiol 17 (3) : 549-554, 1996 17) Murayama Y, Nien YL, Duckwiler G, et al: Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98 (5) : 959-966, 2003 1) Asgari S, Doerfler A, Wanke I, et al: Complementary management of partially occluded aneurysms by using surgical or endovascular therapy. J Neurosurg 97 (4) : 843-850, 2002 15) Mericle RA, Wakhloo AK, Lopes DK, et al: Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report. J Neurosurg 89 (1) : 142-145, 1998 20) Shanno GB, Armonda RA, Benitez RP, et al: Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms. Neurosurgery 48 (5) : 1066-1072; discussion 1072-1064, 2001 22) Thornton J, Bashir Q, Aletich VA, et al: What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46 (6) : 1294-1298; discussion 1298-1300, 2000 5) Drake CG, Friedman AH, Peerless SJ: Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61: 848-856, 1984 16) Molyneux A, Kerr R, Stratton I, et al: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360 (9342) : 1267-1274, 2002 2) Cekirge HS, Islak C, Firat MM, et al: Endovascular coil embolization of residual or recurrent aneurysms after surgical clipping. Acta Radiol 41 (2) : 111-115, 2000 4) Debrun GM, Aletich VA, Kehrli P, et al: Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 43 (6) : 1281-1295; discussion 1296-1287, 1998 19) Rabinstein AA, Nichols DA: Endovascular coil embolization of cerebral aneurysm remnants after incomplete surgical obliteration. Stroke 33 (7) : 1809-1815, 2002 21) Solander S, Ulhoa A, Vinuela F, et al: Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg 90 (5) : 857-864, 1999 23) Winn HR, Almaani WS, Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59 (4) : 642-651, 1983 8) Juvela S, Porras M, Heiskanen O: Natural history of unruptured intracranial aneurysms: a long-term follow-up study. J Neurosurg 79 (2) : 174-182, 1993 12) Lubicz B, Leclerc X, Gauvrit JY, et al: Endovascular treatment of remnants of intracranial aneurysms following incomplete clipping. Neuroradiology 46 (4) : 318-322, 2004 9) Lawton MT, Daspit CP, Spetzler RF: Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41 (3) : 513- 520; discussion 520-511, 1997 7) Hoh BL, Putman CM, Budzik RF, et al: Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization. J Neurosurg 95 (1) : 24-35, 2001 13) MacDonald RL, Wallace MC, Kestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79: 826-832, 1993 18) Niemann DB, Wills AD, Maartens NF, et al: Treatment of intracerebral hematomas caused by aneurysm rupture: coil placement followed by clot evacuation. J Neurosurg 99 (5) : 843-847, 2003 |
| References_xml | – reference: 10) Lawton MT, Hinojosa AQ, Sanai N, et al: Combined microsurgical and endovascular management of complex intracranial aneurysms. Neurosurgery 52: 263-275, 2003 – reference: 21) Solander S, Ulhoa A, Vinuela F, et al: Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg 90 (5) : 857-864, 1999 – reference: 6) Henkes H, Fischer S, Weber W, et al: Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54 (2) : 268-280; discussion 280-265, 2004 – reference: 19) Rabinstein AA, Nichols DA: Endovascular coil embolization of cerebral aneurysm remnants after incomplete surgical obliteration. Stroke 33 (7) : 1809-1815, 2002 – reference: 22) Thornton J, Bashir Q, Aletich VA, et al: What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46 (6) : 1294-1298; discussion 1298-1300, 2000 – reference: 14) Massoud TF, Guglielmi G, Vinuela F, et al: Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR Am J Neuroradiol 17 (3) : 549-554, 1996 – reference: 1) Asgari S, Doerfler A, Wanke I, et al: Complementary management of partially occluded aneurysms by using surgical or endovascular therapy. J Neurosurg 97 (4) : 843-850, 2002 – reference: 8) Juvela S, Porras M, Heiskanen O: Natural history of unruptured intracranial aneurysms: a long-term follow-up study. J Neurosurg 79 (2) : 174-182, 1993 – reference: 2) Cekirge HS, Islak C, Firat MM, et al: Endovascular coil embolization of residual or recurrent aneurysms after surgical clipping. Acta Radiol 41 (2) : 111-115, 2000 – reference: 18) Niemann DB, Wills AD, Maartens NF, et al: Treatment of intracerebral hematomas caused by aneurysm rupture: coil placement followed by clot evacuation. J Neurosurg 99 (5) : 843-847, 2003 – reference: 23) Winn HR, Almaani WS, Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59 (4) : 642-651, 1983 – reference: 20) Shanno GB, Armonda RA, Benitez RP, et al: Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms. Neurosurgery 48 (5) : 1066-1072; discussion 1072-1064, 2001 – reference: 12) Lubicz B, Leclerc X, Gauvrit JY, et al: Endovascular treatment of remnants of intracranial aneurysms following incomplete clipping. Neuroradiology 46 (4) : 318-322, 2004 – reference: 5) Drake CG, Friedman AH, Peerless SJ: Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61: 848-856, 1984 – reference: 11) Lot G, Houdart E, Cophignon J, et al: Combined management of intracranial aneurysms by surgical and endovascular treatment. Modalities and results from a series of 395 cases. Acta Neurochir (Wien) 141: 557-562, 1999 – reference: 3) Day AL: Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72 (5) : 677-691, 1990 – reference: 7) Hoh BL, Putman CM, Budzik RF, et al: Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization. J Neurosurg 95 (1) : 24-35, 2001 – reference: 17) Murayama Y, Nien YL, Duckwiler G, et al: Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98 (5) : 959-966, 2003 – reference: 13) MacDonald RL, Wallace MC, Kestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79: 826-832, 1993 – reference: 9) Lawton MT, Daspit CP, Spetzler RF: Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41 (3) : 513- 520; discussion 520-511, 1997 – reference: 16) Molyneux A, Kerr R, Stratton I, et al: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360 (9342) : 1267-1274, 2002 – reference: 4) Debrun GM, Aletich VA, Kehrli P, et al: Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 43 (6) : 1281-1295; discussion 1296-1287, 1998 – reference: 15) Mericle RA, Wakhloo AK, Lopes DK, et al: Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report. J Neurosurg 89 (1) : 142-145, 1998 |
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| Snippet | 「はじめに」近年, 脳動脈瘤に対する治療法は開頭クリッピング術と血管内治療とが併存しており6)16)17), 治療現場ではそれぞれの治療法の長所短所を考慮して治療選択を行うことが必要となっている. しかしながら動脈瘤の形態によってはどちらかの単一治療法では治療困難な症例が存在する.... |
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| Title | 脳動脈瘤治療における補助的血管内または外科治療の有用性 |
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