내경동맥 상벽 동맥류의 수술적 치험
Surgical Consideration for Internal Carotid Superior Wall Aneurysm
소속 상세정보
김태선/Tae Sun Kim
이제혁/이정길/정신/강삼석/Je Hyuk Lee/Jung Gil Lee/Shin Jung/Sam Suk Kang
KMID : 0359819980270081067
Abstract
결론
내경동맥 상벽 동맥류는 그 발생빈도가 매우 드물고 뇌동맥류의 약 1%을 차지한다 발생기
전은 내경동맥벽의 동맥경화증 또는 해리성 변화 등 여러 가지로 설명하고 있으며 동맥류의
경부가 넓고 얇아서 수술시 조기파열이 자주 발생하는 특징을 가지고 있어, 수술전 뇌혈관
조영술시 이러한 점을 예견하여 실비우스구를 되도록 넓게 열고 적절한 임시결찰을 시행하
여 되도록 동맥류 크립이 모혈관과 평행하게 또 clip head가 뇌 기저부로 향하도록 강부직
접결찰을 시행한다 또한 silastic sheet을 이용한 wrap-clipping은 방추상동맥류나 동맥류의
경부가 얇거나 약한 경우 좋은 방법이라 할 수 있으며 본 증례도 silastic material을 이용한
wrap-clipping방법을 이용하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.
#초록#
Seven cases of aneurysm arising from the superior wall of the internal carotid artery
were operated on from January 1993 through December 1997. They consist of 3.7%
among 191 operated cases of the internal carotid artery aneurysms and 1.2% among 590
operated cases of total intracranial aneurysms.
Aneurysms adhension to the optic nerve was observed in five cases and the
arteriosclerotic change in two cases. Four aneurysms were blister-like and thin-walled,
and the other two aneurysms were covered with thick hematoma. Premature rupture
occurred in three cases, two cases during aneurysmal clipping and one case during
aneurysmal dissection. In three cases the aneurysms were clipped, and in the other four
cases the aneurysms were wrapped circumferentially with the dacron mesh silastic sheet
and clipped. Among the four wrap-clipping cases, two cases were associated with very
fragile aneurysmal walls. There were neither clip sliding nor the regrowth of aneurysms
on the following angiograms. The Glasgow Outcome Scale at discharge showed good
recovery in five cases, moderately disabled in one case, and severely disabled in one
case. In conclusion, wrap-clipping with the silastic sheet is helpful for the superior wall
aneurysms of internal carotid artery with very fragile and thin walls or avulsion of
aneurysmal neck.
키워드
Superior wall; Internal carotid artery aneurysm; Warp-Cliping; Silastic sheet;
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