末梢性前大脳動脈瘤35症例の検討

Abstract

Between April 1978 and March 1989, 35 patients with 38 distal cerebral artery (DACA) aneurysms were admitted to our hospital. Of the 35 patients, 34 underwent microsurgical operation (clipping of 36 saccular aneurysms and wrapping of one fusiform). This group comprised 5.5% of the 642 patients with intracranial aneurysms managed surgically during this period at Shinsyu University and Aizawa Hospital. Their ages ranged from 28 to 74 years (mean 54 years); 14 were male and 21 were female.Twenty-seven patients suffered subarachnoid hemorrhage (SAH) and one of these died from rebleeding before surgery. The remaining 8 cases were incidental (6 cases with SAH due to associated aneurysms in other locations, one with cerebral thrombosis and one with thalamic hemorrhage).Thirty-one of the DACA aneurysms (82%) were located at the genu of the corpus callosum. Medium-sized aneurysms (7-14mm) comprised 16 (42%). Ten patients (29%) had multiple aneurysms; Azygos ACA was noted in 6 cases and Triplicated ACA in 2. On the basis of the preoperative CT findings, the 26 cases of ruptured DACA aneurysms were classified into four types: Type 1 (3 cases) with thin SAH detected in anterior interhemispheric fissure, Type 2 (10 cases) with intracerebral hematoma, Type 3 (8 cases) with diffuse SAH extending to the basal cistern, Type 4 (5 cases) with intraventricular hematoma. Types 3 and 4 were associated with poor preoperative condition and unfavorable prognosis. Operative results of 26 cases with ruptured DACA aneurysms were full recovery (excellent and good) in 20, minimal deficits (fair) in 3, moderately disabled (poor) in 1, death in 2; All 8 patients with unruptured DACA aneurysms recovered fully. Two intraoperative premature ruptures occurred; one patient died and the other was disabled. The present paper describes our surgical approach to the DACA aneurysm and stresses the usefulness of tentative clipping of the aneurysm.