ＧＤＣによる塞栓術導入後の脳動脈りゅうの治療選択と成績

Abstract

Recently, embolization using the Guglielmi detachable coil (GDC) has been performed as an alternative of direct surgery for cerebral aneurysms. We report clinical results and selection of treatment for cerebral aneurysms after introduction of GDC embolization at Wakayama Medical University and related hospitals. From 1997 to December 2001, 895 patients with intracranial aneurysms were treated either by direct surgery (n=798) or by GDC embolization (n=97). In 239 patients with unruptured aneurysms, 194 patients (81%) underwent direct surgery, while 45 patients (19%) had GDC embolization. In 656 patients with ruptured aneurysms, 604 cases (92%) were treated by direct surgery and 12 cases (8%), by GDC embolization. GDC embolization tended to be selected for paraclinoid IC or posterior fossa aneurysms, especially BA top, BA trunk and VA dissecting aneurysms. Vasospasm after SAH was statistically less in the embolization group than in the surgical group. In unruptured aneurysm series, morbidity and mortality rate of direct surgery was 5.7% and 0.5%, respectively, while those of GDC embolization was 4.4% and 0%, respectively. These clinical outcomes seemed to be almost the same as the previously published data by other neurosurgeons and interventional neuroradiologists. Therefore, our treatment selection and procedures are likely to be appropriate, especially in the unruptured group, after introduction of GDC embolization.