Neurological Surgery 脳神経外科38巻1号

2010年01月発行

研究

内頚動脈閉塞による広範囲脳梗塞に対する側頭葉前方内側切除を伴う外減圧術の治療成績

著者： 山崎貴明¹ 上山憲司¹ 大里俊明¹ 佐々木雄彦¹ 中川原譲二¹ 中村博彦¹

所属機関： ¹中村記念病院脳神経外科

ページ範囲：P.25 - P.32

Ⅰ．はじめに

　中大脳動脈灌流領域を含む広範囲脳梗塞のうち“malignant middle cerebral artery（MCA）infraction”は，内頚動脈もしくはMCA proximalの主に塞栓性閉塞により，急速に進行する致死的脳腫脹で，78％がuncal herniationを来すとされている⁶⁾．そのmortalityは80％に及ぶ極めて予後不良の疾患である^1,6,7,23)．特に内頚動脈閉塞は，近年行われるようになったrt-PA（アルテプラーゼ）静注療法の効果も乏しく¹⁷⁾，その梗塞の範囲は中大脳動脈の灌流領域のみならず，前大脳動脈，後大脳動脈の灌流領域といった多血管領域に渡ることもある重症脳梗塞の1つである．われわれは，内頚動脈閉塞による広範囲脳梗塞に伴う著明な脳腫張に対し，救命目的で硬膜形成を伴う外減圧術に，内減圧として側頭葉前方および内側切除（anterior and medial temporal lobectomy：AMTL）を加えた内外減圧術を行ってきたので，その治療成績につき報告する．

参考文献

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