後方発育したＡ１部前大脳動脈瘤５例の治療経験

DOI 被引用文献1件 参考文献26件

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  • Treatment of Posteriorly Projecting Aneurysm at the Proximal (A1) Segment of the Anterior Cerebral Artery: Report of 5 Cases

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Aneurysms of the proximal segment of the anterior cerebral artery (A1An) are difficult to treat surgically because of the proximity of perforating arteries frequently adherent to the A1An dome. Among A1Ans, posteriorly projecting A1An represents much more challenge for surgical clipping due to the location behind the parent artery which covers the aneurysm neck and dome. In the last 2 years, 5 patients (8.9% of the treated 56 cerebral aneurysms in our hospital) were identified with a posteriorly projecting A1An. Neck clipping of the A1An was performed in 4 cases via pterional craniotomy, and 3 developed a new cerebral infarction in the territory of the perforators, while in 1 patient we could not evaluate the blood flow of the perforating arteries because of a large intracerebral hematoma. Only 1 patient was treated by selective embolization from the ipsilateral side with no infarction, although catheterization was difficult. Causative factors of postoperative infarction were limited surgical field, direct injury or occlusion of the perforators and compression with either the clip blade or the clip body. <br> We report a consecutive series of 5 patients with posteriorly projecting A1An focusing on the surgical considerations with a review of the literature.<br>

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  • 脳卒中の外科

    脳卒中の外科 38 (6), 409-414, 2010

    一般社団法人 日本脳卒中の外科学会

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