クリッピング術とコイル塞栓術 未破裂脳動脈瘤治療におけるクリッピング術とコイル塞栓術の手術侵襲の比較

Abstract

We compared the surgical stress to brain tissue between surgical clipping (SC) and endovascular coil embolization (CE) for unruptured intracranial aneurysm. We retrospectively analyzed 10 consecutive cases of unruptured intracranial aneurysms and evaluated serum neuron specific enolase (NSE) and S100β protein at postoperative day 1, 2, and 3. All 10 cases showed good recovery without any neurological sequelae. Mean operation times were 333.6±95.5 min in the SC group and 129.4±30.0 min in the CE group, respectively (p＜0.01, Mann-Whitney test). Peak serum CRP levels were statistically higher in the SC group than in the CE group (p＜0.01, Mann-Whitney test). There was no statistical difference in postoperative serum NSE or S100β between the SC and CE groups. Serum NSE and S100β are widely used to analyze brain damage, including brain contusion, subarachnoid hemorrhage and cerebral infarction, but these biochemical markers are never used to investigate the surgical stress for the treatment of unruptured intracranial aneurysms. The results of our study are limited, because of the small number of case studies and do not reflect even when the eloquent brain structures are damaged or resected. Serologically, SC is not more invasive to brain tissue than CE in the treatment of unruptured intracranial aneurysms. However, the postoperative hospital stay in CE is shorter than in SC, because of the surgical stress for the craniotomy, not brain damage.