著者

都築 伸介 豊岡 輝繁 景山 寛志

出版者

一般社団法人日本脳神経外科コングレス

雑誌

脳神経外科ジャーナル (ISSN:0917950X)

巻号頁・発行日

vol.25, no.9, pp.765-771, 2016 (Released:2016-09-25)

参考文献数

27

被引用文献数

2 1

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硬膜下血腫を合併した低髄液圧症候群の病態は複雑で, さまざまな治療法および治療経過が報告されている. その理由は, 硬膜下血腫の病態が単一ではなく, また同一症例であっても治療を行う時期によって血腫の病態が異なるためではないかと推察される. 適切な治療を行うためには, 治療を開始する時点での血腫の病態を正確に把握することが重要である. われわれは血腫の病態を把握する目的で血腫腔内圧モニタリングを試みた. 結果, 血腫の病態が可視化され, これを正確に把握することが可能となり, 適切な治療を行い得た. 本法は保存的治療が無効な, 硬膜下血腫合併低髄液圧症候群に対する治療の選択肢となり得ると思われた.

著者

都築 伸介 大井川 秀聡 豊岡 輝繁 魚住 洋一 長田 秀夫 鈴木 隆元 宮澤 隆仁 苗代 弘 島 克司

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.37, no.5, pp.375-378, 2009 (Released:2010-04-16)

参考文献数

4

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A 74-year-old man presented with subarachnoid hemorrhage (SAH) and underwent neck clipping of a left middle cerebral artery (MCA) aneurysm 10 years ago. This patient presented with SAH again due to rupture of a de novo aneurysm of the anterior communicating artery (A-com. aneurysm). The A-com. aneurysm was clipped successfully. The “old” left MCA aneurysm was then inspected. A collapsed “old” aneurysmal dome and a previously applied clip were identified. The “old” aneurysmal dome was resected for histopathological examination. The wall of this aneurysmal dome varied in thickness and consisted of a thin layer of fibrous connective tissue. Fibroblasts were scattered in the aneurysmal wall and either the muscular layer or internal elastic lamina was absent. The aneurysmal dome collapsed to a certain degree, but the lumen of the dome was completely intact. In addition, neovascularization of microcapillaries was observed both inside and outside the aneurysmal dome. Some of these microcapillaries were filled with fresh erythrocytes. Thus the aneurysmal wall was apparently “vigorous.” The previous orifice of the aneurysm did not fuse together at all and could be opened widely with ease during preparation for histopathologic examination. We speculated that the clipped aneurysmal dome survived for 10 years for the following reasons: 1) Although the mechanism of neovascularization of the microcapillaries is unclear, the clipped aneurysmal dome may have obtained nourishment from the microcapillaries. 2) The cerebrospinal fluid may have incubated the dome and provided optimal circumstances for its survival. Considering the radical cure for ruptured cerebral aneurysms by neck clipping or coil embolization, the findings described in this report will be valuable for neurosurgeons and neurointerventionists. Regardless of the time since treatment, ruptured aneurysms treated by either neck clipping and/or coil embolization are at risk of recurrent subarachnoid hemorrhage when the blood re-enters the aneurysms in cases such as clip slip-off or coil compaction.