ネック近傍に親血管壁のひ薄化を伴った中大脳動脈りゅうのクリッピングにおける工夫

Abstract

Twelve (43%) out of a total of 28 patients with middle cerebral artery aneurysms had reddish thinning in the parent artery close to aneurysmal neck. The conventional technique of aneurysmal neck clipping with the clip blades parallel to the parent vessel usually does not take care of this weak point, which is liable to rupture. In this study, we describe a technique of wrapping of this weak spot simultaneously with the clipping of the aneurysmal neck. At first, a sheet of Bemsheet (non-fabric cotton) is wrapped around the M2 origin to cover the weak point. Then the aneurysmal neck is clipped over the Bemsheet. This procedure provides a tight reinforcement without leaving any space between the arterial wall and Bemsheet, in contrast to wrapping after neck clipping, which can only form a loose reinforcement. Plastic adhesives were not used in order to avoid the possibility of delayed narrowing of the parent artery. This procedure may also be useful in a case of aneurysm with a red neck, where Bemsheet plays the role of a cushion and lessens the possibility of neck avulsion during clipping.