動眼神経麻痺などの脳神経症状をきたした未破裂脳動脈瘤の症例では、これまで多くの場合、開頭による脳動脈瘤クリッピング術が実施されてきました。しかし、症例をきちんと選べさえすれば、血管内手術によるコイル塞栓術も十分有効な治療オプションとなりうることを、今回、当科の大学院生、高 正圭先生が論文としてまとめて発表してくれました。
同様の論文は海外でも増えつつあり、今後の発展が期待されます。
写真は、高先生とレジデント・山本修輔先生による顕微鏡手術中のスナップです。
高 正圭、桑山直也、秋岡直樹、柏崎大奈、黒田 敏
「脳神経症状を呈した未破裂脳動脈瘤に対するコイル塞栓術の治療成績」
脳外 43:893-900, 2015
http://www.ncbi.nlm.nih.gov/pubmed/26435368
A Voyage to Depth of Neuroscience Vol. 23
Koh S, Kuwayama N, Akioka N, Kashiwazaki D, Kuroda S
Effects of Endovascular Treatment on Cranial Nerve Palsy due to Unruptured Intracranial Aneurysms
No Shinkei Geka. 2015 Oct;43(10):893-900
Abstract:
This study aimed to assess the effects of endovascular treatment on cranial nerve palsy due to unruptured intracranial aneurysms. Endovascular coiling was performed in 203 patients with intracranial aneurysms between April 2002 and March 2012 in our hospital. Of these patients, 8(3.9%)presented with cranial nerve palsy due to unruptured intracranial aneurysms. Cranial nerve palsy involved the oculomotor nerve in 8 patients and the optic nerve in 2 patients. Two patients had both optic nerve and oculomotor nerve dysfunction. Patients with incomplete oculomotor nerve palsy at admission were more likely to have full recovery after coiling. Optic nerve dysfunction did not improve after coiling. Incomplete oculomotor nerve palsy, early treatment(≤15 days), and small aneurysms(≤10 mm)were likely to be associated with complete recovery after coiling. This study indicates that endovascular coiling may resolve cranial nerve palsy due to unruptured intracranial aneurysms in patients who have incomplete oculomotor nerve palsy due to small aneurysms and are treated as early as possible after symptom onset.
