Neurological Surgery 脳神経外科41巻10号

2013年10月発行

連載 合併症のシステマティック・レビュー―適切なInformed Consentのために

（10）未破裂脳動脈瘤に対する血管内治療

著者： 大石英則¹² 山本宗孝² 野中宣秀² 新井一²

所属機関： ¹順天堂大学医学部脳神経血管内治療科 ²順天堂大学医学部脳神経外科

ページ範囲：P.907 - P.916

Ⅰ．はじめに

　Magnetic resonance angiography（MRA）やthree-dimensional computed tomographic angiography（3D-CTA）などの低侵襲検査法が広く普及し，未破裂脳動脈瘤の発見頻度が高まっている．こうした背景において，医師は患者に対して経過観察を含めた治療法を説明する義務がある．特に，外科的介入である開頭術（クリッピング術）と血管内治療について適切なインフォームドコンセントを行うことが求められる．しかし，1人の医師が双方の治療法に精通していることは少なく，自らの経験を踏まえて合併症リスクを説明することは難しい．そこで本稿は，日常診療において血管内治療に直接関わることが少ない医師が主な読者であることを前提とし，未破裂脳動脈瘤に対する血管内治療（コイルを用いて動脈瘤のみを閉塞する手技：コイリング術）の合併症リスクをシステマティック・レビューすることで，インフォームドコンセントを行う上での一助となることを目的とした．したがって，クリッピング術とコイリング術の優越を比較するものではなく，母血管永久閉塞術を含めた検討は行っていない．

　コイリング術もクリッピング術と同様に対象とする患者や術者の力量によって治療成績は大きく異なる．このため，合併症リスクは患者および術者側の背景を鑑みて総合的に判断されるべきものであり，過去の論文データから捉えられる数値を鵜呑みにして説明できるものではないことは強調したい．

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