脳虚血疾患に合併した未破裂脳動脈瘤の治療

We have experienced thirty-four cases with incidental unruptured aneurysms in ischemic cerebrovascular diseases. All of the aneurysms were surgically treated. There were 16 males and 18 females. The mean age was 60. The ischemic symptoms were TIA in six cases, RIND in four, and completed stroke in 21. Unruptured aneurysms were distributed at ICA (15), MCA (11), A corn (6), ACA (5) and BA (1). The mean diameter of the aneurysms was 5.7mm. CT showed low density areas in 24 cases. Atherosclerotic obstructive changes of major cerebral arteries were found in 11 cases. Thirty-four of 38 aneurysms were clipped and four were coated. STA-MCA anastomosis was added at the same stage of aneurysms operation in two cases and carotid endarterectomy was done one month after the obliteration of aneurysms in two cases. Twenty-four of 34 cases had no postoperative symptoms, seven cases showed transient symptoms and two permanent neurological dificits. One patient died due to postoperative bilateral intracerebral hematoma. Surgical complications consisted of six seizures, six subdural effusions, three intracerebral hematomas, two meningitis, one brainstem infarction and a minor epidural hematoma. Status epilepticus occurred in two cases without prophylactic anticonvulsant. Subdural effusions in two cases turned out to be chronic subdural hematomas. One of three intracerebral hematomas was an ipsilateral hematoma and another was a remote hematoma.<BR>In review of our series and other reports, the morbidity and mortality of the direct operations for unruptured aneurysms with ischemic symptoms are relatively high compared to other unruptured aneurysms. Patients who are over 70 years old, have severe atherosclerotic changes of major cerebral arteries, ventriculomegaly or severe brain atrophy, should be considered to be high-risk cases for surgery on unruptured aneurysms. Preoperative prophylactic administration of an anticonvulsant is indispensable.