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過去10年間の当院における未破裂脳底動脈先端部動脈瘤39症例(直達手術,コイル塞栓術,経過観察)の治療成績とその後の転帰について調査,検討し報告する.直達手術は7例に施行され,開頭クリッピング5例,ラッピング2例であった.コイル塞栓術は10例に施行され,8例がcomplete occlusion,1例がneck remnant,1例がdome fillingであった.直達手術群における永続性合併症はクリッピングを施行された1例で生じ(動眼神経麻痺),長期経過においてラッピング術を施行した1例に破裂を経験した.コイル塞栓群では治療合併症はなく,術後画像評価において所見の増悪や破裂は認められなかった.外科治療群全体における治療合併症,治療後の破裂率ともに5.9%という結果であった.一方,経過観察群22例においては6例(27.3%)と高率に破裂を経験した(年間破裂率9.2%).未破裂脳底動脈先端部動脈瘤は破裂しやすく,積極的に治療を考慮する必要がある.
We retrospectively analyzed the ten year results of our experience in the treatment of 39 unruptured basilar artery tip aneurysms by either conservative treatment or surgical treatment (direct surgery or coil embolization). Direct surgery was performed in seven cases. Successful clipping was performed in five cases, and wrapping in two cases. Endovascular treatment was performed in ten cases. There were eight cases of complete occlusion, one case of neck remnant, one case of dome filling. Therapeutic result of surgical treatment were 5.9% permanent morbidity and no mortality. Long-term follow-up revealed only one aneurysmal rupture in the surgical group. Conservative treatment in 22cases, aneurysmal rupture was found in six cases (annual rupture rate was 9.2%). Our management of the unruptured basilar artery tip aneurysms provide satisfactory therapeutic result in the surgical group. It is important in selecting the best method of treatment for the unruptured basilar artery tip aneurysms: direct surgery, endovascular treatment, conservative treatment.
