破裂脳動脈瘤に対する coating は有効か

Abstract

In this paper, we report the long-term results of the treatment of 23 intracranial ruptured aneurysms by coating. Twenty three patients treated by coating were followed for a mean period of 11.2 years. The mean interval between the last hemorrhage and the surgery was 22.4 days. Ten aneurysms underwent total coating, nine with Biobond and one with Aron alpha. Thirteen aneurysms underwent partial coating, 11 with Biobond and two with Aron alpha. Six aneurysms were partialy reinforced by other materials, but no aneurysm was totally wrapped with these materials. Rebleeding occurred in six patients, and five patients died. The mean interval between the coating and the rebleeding was four years. All patients suffering rebleeding had been treated with Biobond, and three patients had undergone total coating of aneurysms. The rate of recurrent hemorrhage after total coating with Biobond was 33%. One patient suffering rebleeding underwent the second surgery 10.5 years after the total coating of the aneurysm. During the surgery, Biobond was not found in the lesion except at the tip of the aneurysmal sac. From these results, we conclude that the reinforcement of ruptured aneurysms with Biobond seems to be of little value, and a more reliable method must be developed for use with aneurysms in which clipping is not technically feasible.