脳動脈瘤のneck clipping後に発生した穿通動脈閉塞症例の検討

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  • Injury of Perforating Arteries during Aneurysmal Surgery

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Injury of perforating arteries resulting from aneurysmal surgery was studied in 780 aneurysmal cases, and seventeen of these (2.2%) revealed a postoperative hypodensity area on CT due to injury of the anterior choroidal artery, the recurrent artery of Heubner, the lateral lenticulostriate artery and the thalamoperforating artery. Cerebral infarction due to injury of these perforating arteries and the outcome of these patients were evaluated by per- and postoperative CT findings, operation records and cerebral angiography.<BR>Of the 17 cases showing a postoperative hypodensity area on CT, 9 cases recovered from neurological deficits, but 8 cases retained moderate to severe neurological deficits. Patients with injury of the Heubner artery showed better outcome, but patients with injury of other perforating arteries showed poor outcome.<BR>Injury of these perforating arteries was caused mainly by improper frontal lobe retraction, blunt dissection or clipping procedure of broad neck or large aneurysms, or temporary clipping of the parent artery. To reduce injury of these perforating arteries during aneurysmal surgery, it is important to execute careful sharp dissection and to expose the entire aneurysmal dome in order to gain precise anatomical understanding as to the perforator, parent artery and aneurysmal neck.

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