Neurological Surgery 脳神経外科51巻2号

2023年03月発行

特集 新時代を迎えた脳血管内治療—文献レビューで学ぶ進歩とトレンド Ⅱ 出血性病変

破裂脳動脈瘤〈適応と成績編〉

著者： 東登志夫¹

所属機関： ¹福岡大学筑紫病院脳神経外科

ページ範囲：P.230 - P.238

Point
・破裂脳動脈瘤に対する外科的治療介入は，頚動脈結紮などを経て，クリッピング術やコイル塞栓術（血管内治療）へと発展してきた．
・ISATやBRATなどの大規模臨床試験では，早期および長期成績においてコイル塞栓術が優位性を示した．リスクは少ないが，再出血や再治療はコイル塞栓術のほうがやや多かった．
・これら臨床試験の結果はガイドラインに反映されてきたが，治療方針を決定する際は，個々の臨床所見や脳動脈瘤の特徴を十分に検討し，最適な治療を選択する必要がある．

参考文献

1）Connolly ES Jr, et al；American Heart Association Stroke Council, et al：Guidelines for the management of aneurysmal subarachnoid hemorrhage：a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43：1711-1737, 2012

2）Milinis K, et al：History of aneurysmal spontaneous subarachnoid hemorrhage. Stroke 48：e280-e283, 2017　doi：10.1161/STROKEAHA.117.017282

3）Cohen-Gadol AA, Spencer DD：Harvey W. Cushing and cerebrovascular surgery：part Ⅰ, aneurysms. J Neurosurg 101：547-552, 2004

4）Mount LA：Results of treatment of intracranial aneurysms using the Selverstone clamp. J Neurosurg 16：611-618, 1959

5）Dandy WE：Intracranial aneurysm of the internal carotid artery：cured by operation. Ann Surg 107：654-659, 1938

6）Kurze T, et al：Experiences with sterilization of the operating microscope. J Neurosurg 47：861-863, 1977

7）Yaşargil MG：A legacy of microneurosurgery：memoirs, lessons, and axioms. Neurosurgery 45：1025-1092, 1999

8）Sugita K, et al：Characteristics and use of ultra-long aneurysm clips. J Neurosurg 60：145-150, 1984

9）Sahs AL, et al：Intracranial Aneurysms and Subarachnoid Hemorrhage：A Cooperative Study. JB Lippincott, Philadelphia, 1969

10）Doby T：Cerebral angiography and Egas Moniz. AJR Am J Roentgenol 159：364, 1992　doi：10.2214/ajr.159.2.1632357

11）Dott NM：Intracranial aneurysms：cerebral arterio-radiography：surgical treatment. Edinb Med J 40：T219-T240, 1933

12）Serbinenko FA：Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41：125-145, 1974

13）Guglielmi G, et al：Electrothrombosis of saccular aneurysms via endovascular approach. Part 1：electrochemical basis, technique, and experimental results. J Neurosurg 75：1-7, 1991

14）Guglielmi G, et al：Electrothrombosis of saccular aneurysms via endovascular approach. Part 2：preliminary clinical experience. J Neurosurg 75：8-14, 1991

15）Molyneux A, et al；International Subarachnoid Aneurysm Trial（ISAT）Collaborative Group：International Subarachnoid Aneurysm Trial（ISAT）of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms：a randomised trial. Lancet 360：1267-1274, 2002

16）Molyneux AJ, et al；International Subarachnoid Aneurysm Trial（ISAT）Collaborative Group：International Subarachnoid Aneurysm Trial（ISAT）of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms：a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366：809-817, 2005

17）Molyneux AJ, et al；ISAT Collaborators：Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial（ISAT）：long-term follow-up. Lancet Neurol 8：427-433, 2009

18）Molyneux AJ, et al：The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms：18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial（ISAT）. Lancet 385：691-697, 2015

19）McDougall CG, et al：The Barrow Ruptured Aneurysm Trial. J Neurosurg 116：135-144, 2012

20）Spetzler RF, et al：The Barrow Ruptured Aneurysm Trial：3-year results. J Neurosurg 119：146-157, 2013

21）Spetzler RF, et al：The Barrow Ruptured Aneurysm Trial：6-year results. J Neurosurg 123：609-617, 2015

22）Spetzler RF, et al：Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg 132：771-776, 2019

23）Investigators C：Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 37：1437-1442, 2006

24）Johnston SC, et al；CARAT Investigators：Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms：the Cerebral Aneurysm Rerupture After Treatment（CARAT）study. Stroke 39：120-125, 2008

25）Li H, et al：Clipping versus coiling for ruptured intracranial aneurysms：a systematic review and meta-analysis. Stroke 44：29-37, 2013

26）吉村紳一，他．：破裂脳動脈瘤におけるEBMの解釈と治療選択．脳神外ジャーナル 17：850-854, 2008

27）Taki W, et al；PRESAT Group：Determinants of poor outcome after aneurysmal subarachnoid hemorrhage when both clipping and coiling are available：Prospective Registry of Subarachnoid Aneurysms Treatment（PRESAT）in Japan. World Neurosurg 76：437-445, 2011

28）Taki W, et al：Factors predicting retreatment and residual aneurysms at 1 year after endovascular coiling for ruptured cerebral aneurysms：Prospective Registry of Subarachnoid Aneurysms Treatment（PRESAT）in Japan. Neuroradiology 54：597-606, 2012

29）Imamura H, et al；JR-NET Investigators：Endovascular treatment of aneurysmal subarachnoid hemorrhage in Japanese Registry of Neuroendovascular Therapy（JR-NET）1 and 2. Neurol Med Chir（Tokyo）54：81-90, 2014

30）Imamura H, et al；JR-NET investigators：Endovascular treatment for vasospasm after aneurysmal subarachnoid hemorrhage based on data of JR-NET 3. Neurol Med Chir（Tokyo）58：495-502, 2018

31）鈴木倫保：くも膜下出血治療に残された課題．脳神外ジャーナル 22：759-769, 2013

32）Kurogi R, et al；J-ASPECT Study Collaborators：Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage：a nationwide study in Japan（J-ASPECT Study）. J Neurosurg 128：1318-1326, 2018

33）Ikawa F, et al：Analysis of outcome at discharge after aneurysmal subarachnoid hemorrhage in Japan according to the Japanese stroke databank. Neurosurg Rev 41：567-574, 2018

34）Ikawa F, et al：Effect of actual age on outcome at discharge in patients by surgical clipping and endovascular coiling for ruptured cerebral aneurysm in Japan. Neurosurg Rev 41：1007-1011, 2018

35）Ikawa F, et al：In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases：a systematic review and meta-analysis. Neurosurg Rev 43：655-667, 2020

36）Mayberg MR, et al：Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Circulation 90：2592-2605, 1994

37）Bederson JB, et al；American Heart Association：Guidelines for the management of aneurysmal subarachnoid hemorrhage：a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 40：994-1025, 2009

38）吉峰俊樹（編）：科学的根拠に基づくくも膜下出血診療ガイドライン．脳卒中の外 31（増刊号），2003

39）篠原幸人，他；脳卒中合同ガイドライン委員会（編）：脳卒中治療ガイドライン2004．協和企画，東京，2004

40）篠原幸人，他；脳卒中合同ガイドライン委員会（編）：脳卒中治療ガイドライン2009．協和企画，東京，2009

41）日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン2015．協和企画，東京，2015

42）日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン2021．協和企画，東京，2021