Neurological Surgery 脳神経外科35巻8号

2007年08月発行

総説

内頸動脈瘤治療における親動脈閉塞およびバイパス術

著者： 清水宏明¹ 冨永悌二²

所属機関： ¹広南病院脳神経外科 ²東北大学大学院神経外科学分野

ページ範囲：P.763 - P.770

Ⅰ．はじめに

　クリッピング術と瘤内塞栓術は脳動脈瘤治療の2つの主柱である．従来本邦では，クリッピング可能なものにはクリッピング術を，そのリスクが高い場合などには瘤内塞栓術を考慮することが多かったが，いずれの手術も困難な脳動脈瘤が稀ならず存在する．内頸動脈瘤については海綿静脈洞部，傍前床突起部の大きなもの，クリッピングや瘤内塞栓後の再増大などが代表的である．

　クリッピング術・瘤内塞栓術がともに困難な場合，親動脈ごと動脈瘤を閉塞する手術が選択されることがあるが，親動脈閉塞に伴う脳虚血を回避するための頭蓋外内バイパス術（以下バイパス術）をいかに有効かつ安全に併用するかが大きな問題の1つである^14,16,44,49)．本稿では，内頸動脈瘤に対する親動脈閉塞およびバイパス術による治療の歴史的背景から具体的な方法，pitfallまでをreviewする．なお，バイパスおよび親動脈閉塞術による治療には，バイパス術をしない単純な親動脈閉塞のみも含むため，親動脈閉塞±バイパス術と表記する．

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