Neurological Surgery 脳神経外科40巻12号

2012年12月発行

連載 脳神経血管内治療医に必要な知識

（4）脳動脈瘤に対する血管内手術の基本手技：simple techniqueによる瘤内塞栓術および親動脈閉塞術の実際

著者： 遠藤英徳¹² 松本康史¹ 近藤竜史¹ 鈴木一郎¹ 菊池登志雄¹ 冨永悌二³

所属機関： ¹広南病院血管内脳神経外科 ²広南病院脳神経外科 ³東北大学大学院神経外科学分野

ページ範囲：P.1107 - P.1118

Ⅰ．はじめに

　脳動脈瘤に対する外科治療（開頭手術および血管内手術）において，血管内手術はデバイスの進化とともに一般化され，その治療数は年々増加している．血管内手術のうち，瘤内塞栓術は脳動脈瘤内にプラチナコイルを充塡して脳動脈瘤を閉塞させることを目的とするが，その手技はsimple techniqueとadjunctive techniqueに大別される．Simple techniqueはデバイスによるアシストなしで脳動脈瘤のtight packingを目標とする．一方，adjunctive techniqueは，バルーン・ダブルカテーテル・ステントなどを駆使してwide neck動脈瘤や巨大動脈瘤など，より治療困難な動脈瘤の根治を目的とする．Adjunctive techniqueはsimple techniqueと比較して手技が煩雑となるため，基本手技であるsimple techniqueの習熟が前提となる．

　本稿では，脳動脈瘤治療に関する最近の知見を概説し，脳動脈瘤に対する瘤内塞栓術，特にsimple techniqueの手技を解説する．また，瘤内塞栓術で治療困難な特殊な動脈瘤（海綿静脈洞部内頚動脈瘤や出血性椎骨動脈解離）に対する親動脈閉塞に関して，手技を中心に解説する．

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