当院における未破裂脳動脈瘤の外科治療 : 特に転帰非良好2症例について  [in Japanese] Surgical Treatment of Unruptured Aneurysm in Our Hospital : Clinical Study for 2 Cases with Unfavorable Outcome  [in Japanese]

Currently, unruptured cerebral aneurysms (U-Ans) are positively treated in conformity with the guideline for the Japanese Society for Detection of Asymptomatic Brain Diseases. Direct operations are performed after informed consent is obtained in U-Ans cases. However, unfortunate outcomes have occurred even if safe surgery was done. Therefore we examined the characteristics of U-Ans and report surgical treatment in our hospital. Consecutive operations (n=45) on 43 patients between January 2005 and October 2007 were included in this study. Surgical neck clipping was performed on all patients. The mean age was 67 years. U-Ans were discovered in medical check-ups in 24 cases (56%), during close examinations of headache and dizziness in 10 cases, examination of oculomotor palsy in 5 cases and examination of ruptured cerebral aneurysm in 2 cases, respectively. The mean U-Ans sizes were 6.1mm in the internal carotid artery, 6.4mm in the anterior cerebral artery and 6.4mm in the middle cerebral artery (MCA), respectively. One basilar top aneurysm 7mm in size was included. Surgical morbidity was recognized in 2 patients (4%). One patient, a 75 year-old male, suffered a left temporal cerebral infarction due to mechanical vasospasm. Another patient, a 67 year-old female, developed a cerebral infarction in the territory of the right MCA due to the compression for MCA during approach for basilartop UAn. We experienced 2 cases with unfortunate outcomes. Surgical complications caused by mechanical damage and vessel compression occurred. These complications in clipping for aneurysms are preventable. More care in performing operative procedures is needed.