Neurological Surgery 脳神経外科37巻6号

2009年06月発行

研究

破裂前交通動脈瘤の治療に対するクリッピング術とコイル塞栓術の症例分配について

著者： 数又研¹ 牛越聡¹ 寺坂俊介² 桜井寿郎¹ 菊地統¹ 横山由佳¹ 浅岡克行¹ 板本孝治¹ 丸一勝彦¹

所属機関： ¹手稲渓仁会病院脳神経外科 ²北海道大学医学部神経外科

ページ範囲：P.553 - P.558

Ⅰ．はじめに

　International Subarachnoid Aneurysm Trial（ISAT）の研究結果は，これまで主に開頭手術で行われてきた破裂前交通動脈瘤の治療にコイル塞栓術という選択肢を加えた^12,13,21)．しかし，ISATの結果を一般化しコイル塞栓術を第一選択とすることには批判もあり，破裂前交通動脈瘤は，pterional approachで開頭手術を第一選択として行っている施設が大多数と思われる^4,5,17)．開頭手術，血管内治療それぞれの利点を高め，リスクを最小限にとどめるような症例の選択を具体的にどうすべきかは不明確である^{7,15,18,19,21)}．

　われわれは2004年4月より破裂動脈瘤は“コイル塞栓術”“開頭手術”それぞれの治療を専門とする医師が動脈瘤の形状，病態を考慮し治療法を決定し，いずれの方法でも治療可能と判断された場合にはコイル塞栓術を第一選択とする方針を採用した¹³⁾．今回，2004年以後の当院における破裂前交通動脈瘤の治療現状を，decision-making processと各治療に分配される頻度についてretrospectiveに検討し両治療の適切な選択に関する考察を行った．

参考文献

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