頭蓋内病変に対する血行再建(<特集>困難を極めた症例・特別なテクニックを要した症例)  [in Japanese] Vascular Reconstructions for Intracranial Lesions(Topics : Special Technique for Complex and Unusual Lesion)  [in Japanese]

雑誌掲載版術中に予期せず生じた母血管損傷の3症例(破裂前交通動脈瘤・Hunt & Kosnik Grade IVの88歳女性,破裂右中大脳動脈瘤・Grade IIの75歳女性,鞍結節髄膜腫の53歳女性)の術中所見を呈示し解説した.自験例の経験から母血管損傷の部位によっては深部での縫合操作が必要となるため,深部縫合用の持針器などのセットは常に使用可能状態にしておく必要があるものと考えられた.静脈損傷による静脈梗塞は動脈性梗塞に比べ時間的余裕があり,多少時間はかかっても再建により静脈梗塞を免れる可能性が高く,いずれにしても術中損傷をきたした動静脈血管は再建することができれば術後の神経学的障害は最少減限に抑えることができる可能性が高いと考えられた

Vascular reconstruction of intracranial lesions is sometimes required during various operations. A few examples are : A3-A3 side-to-side anastomosis for anterior communicating aneurysm in order to secure the blood flow to the distal anterior cerebral artery, STA-radial artery graft-A3 hemibonnet bypass for bilateral injury of the anterior cerebral artery, and direct stitching for aneurysmal neck laceration, etc. In this paper we describe the various techniques of vascular reconstruction for intracranial lesions and tumors. Some special microsurgical instruments, such as a micro-needle folder for stitching in a deep field, should be sterilized individually, and be ready for use at any time because injury to vessels in a deep operative field occurs suddenly. If the injured vessels are reconstructed quickly and completely, the neurological deficits after surgery can be limited and at times even prevented. Therefore veins or arteries that are or have been damaged should be reconstructed as much as possible.