Neurological Surgery 脳神経外科36巻9号

2008年09月発行

解剖を中心とした脳神経手術手技

脳動脈瘤に対する血管内治療―コイル瘤内塞栓術

著者： 大石英則¹ 新井一¹

所属機関： ¹順天堂大学医学部脳神経外科

ページ範囲：P.755 - P.767

Ⅰ．はじめに

　欧米を中心とした，破裂脳動脈瘤に対するクリッピング術と血管内治療の多施設共同比較試験であるISAT（international subarachnoid aneurysm trial）研究^10,11)で血管内治療の有効性が報告されて以降，その低侵襲性への期待もあり，本邦でも血管内治療はクリッピング術と同じく脳動脈瘤に対する重要な治療法となっている．そこで，本稿では脳動脈瘤に対する血管内治療，特にコイルを用いた瘤内塞栓術について手術手技を中心に説明する．

参考文献

1）Baldi S, Mounayer C, Piotin M, Spelle L,Moret J：Balloon-assisted coil placement in wide-neck bifurcation aneurysms by use of a new, compliant balloon microcatheter. AJNR Am J Neuroradiol 24：1222-1225, 2003

2）Baxter BW, Rosso D, Lownie SP：Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol 19：1176-1178, 1998

3）Biondi A, Janardhan V, Katz JM, Salvaggio K, Riina HA, Gobin YP：Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms：strategies in stent deployment and midterm follow-up. Neurosurgery 61：460-468；discussion 468-469, 2007

4）Cloft HJ, Joseph GJ, Tong FC, Goldstein JH,Dion JE：Use of three-dimensional Guglielmi detachable coils in the treatment of wide-necked cerebral aneurysms. AJNR Am J Neuroradiol 21：1312-1314, 2000

5）Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI,Charbel F：Selection of cerebral aneurysms for treatment using Guglielmi detachable coils：the preliminary University of Illinois at Chicago experience. Neurosurgery 43：1281-1295；discussion 1296-1297, 1998

6）Kawanabe Y, Sadato A, Taki W,Hashimoto N：Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils：correlation between coil packing density and coil compaction. Acta Neurochir (Wien) 143：451-455, 2001

7）Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP,Pruvo JP：HyperForm remodeling-balloon for endovascular treatment of wide-neck intracranial aneurysms. AJNR Am J Neuroradiol 25：1381-1383, 2004

8）Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP：Three-dimensional packing with complex orbit coils for the endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26：1342-1348, 2005

9）Lubicz B, Leclerc X, Levivier M, Brotchi J, Pruvo JP, Lejeune JP, Baleriaux D：Retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms：preliminary experience. Neurosurgery 58：451-457；discussion 451-457, 2006

10）Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R；International Subarachnoid Aneurysm Trial (ISAT) Collaborative group：International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms：a randomised trial. Lancet 360：1267-1274, 2002

11）Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P；International Subarachnoid Aneurysm Trial (ISAT) Collaborative group：International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms：a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366：809-817, 2005

12）Moret J, Cognard C, Weill A, Castaings L, Rey A：Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 24：30-44, 1997

13）Nakahara T, Kutsuna M, Yamanaka M,Sakoda K：Coil embolization of a large, wide-necked aneurysm using a double coil-delivered microcatheter technique in combination with a balloon-assisted technique. Neurol Res 21：324-326, 1999

14）Park HK, Horowitz M, Jungreis C, Kassam A, Koebbe C, Genevro J, Dutton K, Purdy P：Endovascular treatment of paraclinoid aneurysms：experience with 73 patients. Neurosurgery 53：14-23；discussion 24, 2003

15）Quadros RS, Gallas S, Noudel R, Rousseaux P, Pierot L：Endovascular treatment of middle cerebral artery aneurysms as first option：a single center experience of 92 aneurysms. AJNR Am J Neuroradiol 28：1567-1572, 2007

16）Ross IB, Dhillon GS：Balloon assistance as a routine adjunct to the endovascular treatment of cerebral aneurysms. Surg Neurol 66：593-601；discussion 601-602, 2006

17）Sadasivan C, Lieber BB, Gounis MJ, Lopes DK, Hopkins LN：Angiographic quantification of contrast medium washout from cerebral aneurysms after stent placement. AJNR Am J Neuroradiol 23：1214-1221, 2002

18）Sluzewski M, van Rooij WJ, Beute GN, Nijssen PC：Balloon-assisted coil embolization of intracranial aneurysms：incidence, complications, and angiography results. J Neurosurg 105：396-399, 2006

19）Sluzewski M, van Rooij WJ, Slob MJ, Bescos JO, Slump CH, Wijnalda D：Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 231：653-658, 2004

20）Tamatani S, Ito Y, Abe H, Koike T, Takeuchi S, Tanaka R：Evaluation of the stability of aneurysms after embolization using detachable coils：correlation between stability of aneurysms and embolized volume of aneurysms. AJNR Am J Neuroradiol 23：762-767, 2002

21）Vinuela F, Duckwiler G, Mawad M：Guglielmi detachable coil embolization of acute intracranial aneurysm：perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86：475-482, 1997