Neurological Surgery 脳神経外科39巻2号

2011年02月発行

解剖を中心とした脳神経手術手技

部分血栓化巨大中大脳動脈瘤に対する手術

著者： 髙橋淳¹ 宮本享¹

所属機関： ¹京都大学大学院医学研究科脳神経外科

ページ範囲：P.129 - P.139

Ⅰ．はじめに

　部分血栓化巨大脳動脈瘤は脳血管外科領域におけるchallengingな疾患の1つである．中大脳動脈は本疾患最大の好発部位であるが，しばしば内腔血栓中を血流チャンネルが蛇行するgiant serpentine aneurysm（GSA）の形態をとる．現在，治療法の第一選択は血行再建術を併用した瘤内血流遮断とされるが，実際には各症例に固有のさまざまな問題点が存在し，さらに解剖学的なvariationが多彩で画一的な対応は難しい．しかし症候化した部分血栓化巨大脳動脈瘤の予後は悪く，消極的な姿勢は正当化されない．本稿では部分血栓化巨大中大脳動脈瘤，なかでも主流を占める中大脳動脈GSAに関する知識，治療デザインとその手術手技について解説する．またこれまで文献上ほとんど語られていない，母血管閉塞時の盲端形成の問題点についても触れたい．

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