フィブリン糊を用いたくも膜形成と“floating bypass”

Abstract

Due to recent developments in MRI and microsurgical techniques and improvement in diagnostic techniques, more aged patients are undergoing craniotomy for surgical operations such as non-ruptured aneurysmal clipping and STA-MCA bypass surgery, during which the brain may collapse due to aspiration of the cerebrospinal fluid. Collapse of the brain could lead to postoperative subdural fluid effusion, which sometimes requires surgical management. Aged patients take a particularly long time to recover postoperatively from complications such as subdural effusion or hematoma due to brain atrophy. This slow recovery often leads to new complications, resulting in a long hospitalization. To resolve this problem, we have designed a new simple technique using a fibrin glue and gelform. We have obtained good results from the use of this method, in which gelform, sliced off to the one third with fibrinogen, was added to thrombin. In addition to the above method, we have also designed a“floating bypass”technique in which the recipient MCA artery is sealed with gelform soaked in fibrin glue and saline is injected into the subarachnoid space using a 5Fr tube. In this paper, we report new simple and effective techniques to prevent postoperative subdural fluid effusion.