未破裂脳動脈りゅう術後の虚血性合併症

Abstract

We treated a series of 125 patients with unruptured intracranial aneurysms (UIAs) over a period of 6 years and 5 months (1995.12.1-2002.4.30). Ninety-seven patients were operated on, 1 was endovascularly embolized, and 27 were observed. Of the 97 patients who were operated on, 4 had postoperative ischemic complications; 2 had a new cerebral infarction, 1 experienced deterioration of the known infarction and 1 had delayed symptomatic vasospasm. The etiologies of the new cerebral infarction were a subclinical pre-existing stenosis of the parent artery around the aneurysmal neck and stenosis of the parent artery induced by inappropriate neck clipping. Worsening of the known cerebral infarction was seen in a recent case of infarction that developed 2 months before surgery. Pathogeneses of the delayed symptomatic vasospasm after surgery for UIAs are unclear, but the important point is that symptomatic vasospasm does occur after surgery for UIAs. These results suggest that asymptomatic stenotic lesions of the parent artery around the aneurysmal neck have a potential to become symptomatic postoperatively and cause cerebral infarction, that a recent infarction is a risk factor of postoperative ischemic complication as is already known and that a delayed spasm can occur even after uneventful surgery for UIAs.