破裂前交通動脈瘤の認知障害の特徴 穿通枝損傷の重要性
破裂前交通動脈瘤44例の脳損傷部位が記憶障害, 注意障害, 複職などの転帰に与える影響を検討した. 記憶障害は88.6%で認め, 復職は50%であった. 前脳基底部の損傷は84.1%で認め, 36.3%は半球間裂血腫によるもの, 47.7%は手術時の穿通枝損傷によるものであった. 前脳基底部損傷により認知障害は重度となり転帰は悪化した. 直回と眼窩回, 尾状核頭の損傷は転帰に影響を与えなかった. 重度記憶障害に対しては前脳基底部損傷, pterional approachが独立した悪化因子であった. 前脳基底部損傷により認知障害は重度となり, 転帰は悪化した....
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| Published in | 脳神経外科ジャーナル Vol. 32; no. 3; pp. 183 - 190 |
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| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
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一般社団法人日本脳神経外科コングレス
2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.32.183 |
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| Abstract | 破裂前交通動脈瘤44例の脳損傷部位が記憶障害, 注意障害, 複職などの転帰に与える影響を検討した. 記憶障害は88.6%で認め, 復職は50%であった. 前脳基底部の損傷は84.1%で認め, 36.3%は半球間裂血腫によるもの, 47.7%は手術時の穿通枝損傷によるものであった. 前脳基底部損傷により認知障害は重度となり転帰は悪化した. 直回と眼窩回, 尾状核頭の損傷は転帰に影響を与えなかった. 重度記憶障害に対しては前脳基底部損傷, pterional approachが独立した悪化因子であった. 前脳基底部損傷により認知障害は重度となり, 転帰は悪化した. |
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| AbstractList | 破裂前交通動脈瘤44例の脳損傷部位が記憶障害, 注意障害, 複職などの転帰に与える影響を検討した. 記憶障害は88.6%で認め, 復職は50%であった. 前脳基底部の損傷は84.1%で認め, 36.3%は半球間裂血腫によるもの, 47.7%は手術時の穿通枝損傷によるものであった. 前脳基底部損傷により認知障害は重度となり転帰は悪化した. 直回と眼窩回, 尾状核頭の損傷は転帰に影響を与えなかった. 重度記憶障害に対しては前脳基底部損傷, pterional approachが独立した悪化因子であった. 前脳基底部損傷により認知障害は重度となり, 転帰は悪化した. |
| Author | 佐藤, 博信 林, 朋子 所, 和彦 |
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| References | 15) Moon K, Levitt MR, Almefty RO, Nakaji P, Albuquerque FC, Zabramski JM, McDougall CG, Spetzler RF : Treatment of ruptured anterior communicating artery aneurysms : Equipoise in the endovascular era? Neurosurgery 77 : 566-571, 2015. 6) 我那覇司, 稲桝丈司, 小田淳平, 早川基治, 定藤章代, 加藤庸子, 中原一郎, 廣瀬雄一 : 破裂前交通動脈瘤における瘤発育方向と治療予後の関連性. 脳卒中の外科 44 : 375-380, 2016. 17) Mugikura S, Kikuchi H, Fujii T, Murata T, Takase K, Mori E, Marinković S, Takahashi S : MR Imaging of subcallosal artery infarct causing amnesia after surgery for anterior communicating artery aneurysm. AJNR Am J Neuroradiol 35 : 2293-2301, 2014. 8) Heit JJ, Ball RL, Telischak NA, Do HM, Dodd RL, Steinberg GK, Chang SD, Wintermark M, Marks MP : Patient outcomes and cerebral infarction after ruptured anterior communicating artery aneurysm treatment. AJNR Am J Neuroradiol 38 : 2119-2125, 2017. 11) 片岡大治, 飯原弘二 : 穿通枝の外科解剖―ICG videoangiographyと神経内視鏡の有用性. 脳外誌 24 : 12-18, 2015. 25) 佐藤 章, 中村 弘, 小林繁樹, 宮田昭宏, 徳永 仁, 和田政則, 渡邊義郎 : 前交通動脈瘤の解剖学的特徴をもとにした手術法の選択と手術手技. 脳卒中の外科 30 : 240-246, 2002. 3) Backer HC, Shoap S, Vajda J, Nyary I : Anterior communicating artery aneurysm rupture and functional outcome in short-term : clipping versus coiling. J Integr Neurosci 19 : 349-354, 2020. 19) 永田和哉 : 前交通動脈瘤の解剖と手術. 脳外誌 13 : 389-394, 2004. 7) Guglielmi G, Vinuela F, Duckwiler G, Jahan R, Cotroneo E, Gigli R : Endovascular treatment of 306 anterior communicating artery aneurysms : overall, perioperative results. J Neurosurg 110 : 874-879, 2009. 9) 一ツ松勤 : 直達外科手術に役立つ脳血管解剖―穿通枝虚血についての考察―. 脳外誌 26 : 515-522, 2017. 1) Alexander MP, Freedman M : Amnesia after anterior communicating artery aneurysm rupture. Neurology 34 : 752-757, 1984. 10) 井川房夫, 日高敏和, 吉山道貫, 大庭秀雄, 松田真伍, 谷口洋樹, 栗栖 薫 : 前交通動脈瘤の特徴と外科手術戦略. 脳卒中の外科 48 : 408-413, 2020. 16) Mortimer AM, Steinfort B, Faulder K, Erho T, Scherman DB, Rao PJ, Harrington T : Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms. J Neurointerv Surg 8 : 256-264, 2016. 5) Finitsis S, Anxionnat R, Lebedinsky A, Albuquerque PC, Clayton MF, Picard L, Bracard S : Endovascular treatment of ACom intracranial aneurysms. Report on series of 280 patients. Interv Neuroradiol 16 : 7-16, 2010. 12) Kim M, Kim B, Son W, Park J : Postoperative clipping status after a pterional versus interhemispheric approach for high-positioned anterior communicating artery aneurysms. J Korean Neurosurg Soc 64 : 524-533, 2021. 20) Najera E, Alves Belo JT, Truong HQ, Gardner PA, Fernandez-Miranda JC : Surgical anatomy of the subcallosal artery : Implications for transcranial and endoscopic endonasal surgery in the suprachiasmatic region. Oper Neurosurg (Hagerstown) 17 : 79-87, 2019. 23) 貫井英明, 宮城 修, 野尻 健, 田中壮佶, 川淵純一, 前田 進, 大川匡子 : 前交通動脈瘤症例における精神症状. Neurol Med Chir (Tokyo) 17 : 335-341, 1977. 26) Scott RB, Eccles F, Molyneux AJ, Kerr RSC, Rothwell PM, Carpenter K : Improved cognitive outcomes with endovascular coiling of ruptured intracranial aneurysms. Neuropsychological outcomes from the international subarachnoid aneurysm trial (ISAT). Stroke 41 : 1743-1747, 2010. 27) 田中敏樹, 布施郁子, 渡邊一良 : 同一術者による前交通動脈瘤clippingのpterional approachにおけるapproach sideおよび手術合併症の検討. 脳卒中の外科 40 : 183-187, 2012. 28) Yaşargil MG, Kasdaglis K, Jain KK, Weber HP : Anatomical observations of the subarachnoid cisterns of the brain during surgery. J Neurosurg 44 : 298-302, 1976. 14) Mayer SA, Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, Du YE, Connolly ES Jr : Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 59 : 1750-1758, 2002. 22) Navratil O, Duris K, Juran V, Svoboda K, Husty J, Hovorka E, Neuman E, Mrlian A, Smrcka M : Current treatment of anterior communicating artery aneurysms : Single center study. Brain Sci 10 : 501, 2020. 13) Laiaconat M, Santis AD, Barbarottol R, Basso A, SpagnoJi D, Capitanil E : Neuropsychological follow-up of patients operated for aneurysms of anterior communicating artery. Cortex 25 : 261-273, 1989. 2) Andaluz N, Zuccarello M : Anterior communicating artery aneurysm surgery through the orbitopterional approach : Long-term follow-up in a series of 75 consecutive patients. Skull Base 18 : 265-274, 2008. 21) Nassiri F, Workewych AM, Badhiwala JH, Cusimano MD : Cognitive outcomes after anterior communicating artery aneurysm repair. Can J Neurol Sci 45 : 415-423, 2018. 18) Mugikura S, Kikuchi H, Fujimura M, Mori E, Takahashi S : Subcallosal and Heubner artery infarcts following surgical repair of an anterior communicating artery aneurysm : a causal relationship with postoperative amnesia and long-term outcome. Jpn J Radiol 36 : 81-89, 2018. 4) Chen J, Li M, Zhu X, Chen Y, Zhang C, Shi W, Chen Q, Wang Y : Anterior communicating artery aneurysms : Anatomical considerations and microsurgical strategies. Front Neurol 11 : 1020, 2020. 24) Proust F, Martinaud O, Gerardin E, Derrey S, Leveque S, Bioux S, Tollard E, Clavier E, Langlois O, Godefroy O, Hannequin D, Freger P : Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms : neuropsychological assessment. J Neurosurg 110 : 19-29, 2009. |
| References_xml | – reference: 27) 田中敏樹, 布施郁子, 渡邊一良 : 同一術者による前交通動脈瘤clippingのpterional approachにおけるapproach sideおよび手術合併症の検討. 脳卒中の外科 40 : 183-187, 2012. – reference: 22) Navratil O, Duris K, Juran V, Svoboda K, Husty J, Hovorka E, Neuman E, Mrlian A, Smrcka M : Current treatment of anterior communicating artery aneurysms : Single center study. Brain Sci 10 : 501, 2020. – reference: 16) Mortimer AM, Steinfort B, Faulder K, Erho T, Scherman DB, Rao PJ, Harrington T : Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms. J Neurointerv Surg 8 : 256-264, 2016. – reference: 8) Heit JJ, Ball RL, Telischak NA, Do HM, Dodd RL, Steinberg GK, Chang SD, Wintermark M, Marks MP : Patient outcomes and cerebral infarction after ruptured anterior communicating artery aneurysm treatment. AJNR Am J Neuroradiol 38 : 2119-2125, 2017. – reference: 11) 片岡大治, 飯原弘二 : 穿通枝の外科解剖―ICG videoangiographyと神経内視鏡の有用性. 脳外誌 24 : 12-18, 2015. – reference: 9) 一ツ松勤 : 直達外科手術に役立つ脳血管解剖―穿通枝虚血についての考察―. 脳外誌 26 : 515-522, 2017. – reference: 7) Guglielmi G, Vinuela F, Duckwiler G, Jahan R, Cotroneo E, Gigli R : Endovascular treatment of 306 anterior communicating artery aneurysms : overall, perioperative results. J Neurosurg 110 : 874-879, 2009. – reference: 17) Mugikura S, Kikuchi H, Fujii T, Murata T, Takase K, Mori E, Marinković S, Takahashi S : MR Imaging of subcallosal artery infarct causing amnesia after surgery for anterior communicating artery aneurysm. AJNR Am J Neuroradiol 35 : 2293-2301, 2014. – reference: 2) Andaluz N, Zuccarello M : Anterior communicating artery aneurysm surgery through the orbitopterional approach : Long-term follow-up in a series of 75 consecutive patients. Skull Base 18 : 265-274, 2008. – reference: 21) Nassiri F, Workewych AM, Badhiwala JH, Cusimano MD : Cognitive outcomes after anterior communicating artery aneurysm repair. Can J Neurol Sci 45 : 415-423, 2018. – reference: 26) Scott RB, Eccles F, Molyneux AJ, Kerr RSC, Rothwell PM, Carpenter K : Improved cognitive outcomes with endovascular coiling of ruptured intracranial aneurysms. Neuropsychological outcomes from the international subarachnoid aneurysm trial (ISAT). Stroke 41 : 1743-1747, 2010. – reference: 19) 永田和哉 : 前交通動脈瘤の解剖と手術. 脳外誌 13 : 389-394, 2004. – reference: 23) 貫井英明, 宮城 修, 野尻 健, 田中壮佶, 川淵純一, 前田 進, 大川匡子 : 前交通動脈瘤症例における精神症状. Neurol Med Chir (Tokyo) 17 : 335-341, 1977. – reference: 1) Alexander MP, Freedman M : Amnesia after anterior communicating artery aneurysm rupture. Neurology 34 : 752-757, 1984. – reference: 5) Finitsis S, Anxionnat R, Lebedinsky A, Albuquerque PC, Clayton MF, Picard L, Bracard S : Endovascular treatment of ACom intracranial aneurysms. Report on series of 280 patients. Interv Neuroradiol 16 : 7-16, 2010. – reference: 15) Moon K, Levitt MR, Almefty RO, Nakaji P, Albuquerque FC, Zabramski JM, McDougall CG, Spetzler RF : Treatment of ruptured anterior communicating artery aneurysms : Equipoise in the endovascular era? Neurosurgery 77 : 566-571, 2015. – reference: 20) Najera E, Alves Belo JT, Truong HQ, Gardner PA, Fernandez-Miranda JC : Surgical anatomy of the subcallosal artery : Implications for transcranial and endoscopic endonasal surgery in the suprachiasmatic region. Oper Neurosurg (Hagerstown) 17 : 79-87, 2019. – reference: 24) Proust F, Martinaud O, Gerardin E, Derrey S, Leveque S, Bioux S, Tollard E, Clavier E, Langlois O, Godefroy O, Hannequin D, Freger P : Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms : neuropsychological assessment. J Neurosurg 110 : 19-29, 2009. – reference: 4) Chen J, Li M, Zhu X, Chen Y, Zhang C, Shi W, Chen Q, Wang Y : Anterior communicating artery aneurysms : Anatomical considerations and microsurgical strategies. Front Neurol 11 : 1020, 2020. – reference: 14) Mayer SA, Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, Du YE, Connolly ES Jr : Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 59 : 1750-1758, 2002. – reference: 18) Mugikura S, Kikuchi H, Fujimura M, Mori E, Takahashi S : Subcallosal and Heubner artery infarcts following surgical repair of an anterior communicating artery aneurysm : a causal relationship with postoperative amnesia and long-term outcome. Jpn J Radiol 36 : 81-89, 2018. – reference: 28) Yaşargil MG, Kasdaglis K, Jain KK, Weber HP : Anatomical observations of the subarachnoid cisterns of the brain during surgery. J Neurosurg 44 : 298-302, 1976. – reference: 12) Kim M, Kim B, Son W, Park J : Postoperative clipping status after a pterional versus interhemispheric approach for high-positioned anterior communicating artery aneurysms. J Korean Neurosurg Soc 64 : 524-533, 2021. – reference: 25) 佐藤 章, 中村 弘, 小林繁樹, 宮田昭宏, 徳永 仁, 和田政則, 渡邊義郎 : 前交通動脈瘤の解剖学的特徴をもとにした手術法の選択と手術手技. 脳卒中の外科 30 : 240-246, 2002. – reference: 13) Laiaconat M, Santis AD, Barbarottol R, Basso A, SpagnoJi D, Capitanil E : Neuropsychological follow-up of patients operated for aneurysms of anterior communicating artery. Cortex 25 : 261-273, 1989. – reference: 6) 我那覇司, 稲桝丈司, 小田淳平, 早川基治, 定藤章代, 加藤庸子, 中原一郎, 廣瀬雄一 : 破裂前交通動脈瘤における瘤発育方向と治療予後の関連性. 脳卒中の外科 44 : 375-380, 2016. – reference: 3) Backer HC, Shoap S, Vajda J, Nyary I : Anterior communicating artery aneurysm rupture and functional outcome in short-term : clipping versus coiling. J Integr Neurosci 19 : 349-354, 2020. – reference: 10) 井川房夫, 日高敏和, 吉山道貫, 大庭秀雄, 松田真伍, 谷口洋樹, 栗栖 薫 : 前交通動脈瘤の特徴と外科手術戦略. 脳卒中の外科 48 : 408-413, 2020. |
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| Snippet | 破裂前交通動脈瘤44例の脳損傷部位が記憶障害, 注意障害, 複職などの転帰に与える影響を検討した. 記憶障害は88.6%で認め, 復職は50%であった. 前脳基底部の損傷は84.1%で認め, 36.3%は半球間裂血腫によるもの, 47.7%は手術時の穿通枝損傷によるものであった.... |
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| SubjectTerms | anterior communicating artery aneurysm cognition memory outcome subcallosal artery |
| Subtitle | 穿通枝損傷の重要性 |
| Title | 破裂前交通動脈瘤の認知障害の特徴 |
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