開頭術または血管内塞栓術後の残存・再発脳動脈瘤に対する開頭術

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  • Surgery for Aneurysms that are Residual or Recurrent after Open or Endovascular Surgery

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Surgical treatment for recurrent aneurysms after clipping or coiling is generally more difficult than the initial treatment.<br>Patients and Methods: This study included 14 patients (3 males and 11 females, mean age 58 years-old) who were surgically treated owing to a remnant aneurysm or recurrence of an aneurysm, after initial surgery or endovascular coil embolization. Patient characteristics and strategy for reoperation were retrospectively reviewed.<br>Results: There were 8 ruptured and 6 unruptured aneurysms before the initial treatment with surgery (7 clipping cases and 1 wrapping case: surgical group) or coil embolization (6 cases: coil group). Presentation before the second surgery was rupture in 2 cases, and remnant or enlargement of the aneurysm in 12 cases. In the surgical cases, the most frequent aneurysm sites were the internal carotidposterior communicating artery, and middle cerebral artery; in the coiled patients, the sites varied. Intervals between the initial treatment and retreatment owing to aneurysmal growth or rupture were 13.5 and 1.5 years in the surgical and coil groups, respectively. In both the surgery and coil groups, incomplete occlusion of the aneurysm was considered to be a factor of regrowth. The second surgery was neck clipping in 10 cases (71%), and bypass followed by parent artery occlusion in 3 cases. Among 10 clipping cases, a previous clip or coil had to be removed in 6, and bypass was used to assist temporary proximal occlusion. In one case treated with bypass and parent artery occlusion, transient ischemic symptoms occurred, but improved after antiplatelet administration. The Glasgow outcome scale at discharge showed good recovery in all cases, except for one with moderate disability due to preexisting hemiparesis.<br>Conclusion: Regrowth in both the surgery and coil groups was associated with incomplete occlusion and large size in the coil group. Surgical retreatment can be successfully accomplished with a strategy that includes careful dissection of the adhesive tissues, clip/coil removal, bypass to assist temporary proximal occlusion, and bypass with parent artery occlusion.

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  • 脳卒中の外科

    脳卒中の外科 43 (3), 212-217, 2015

    一般社団法人 日本脳卒中の外科学会

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