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전교통동맥류 수술에 대한 임상적 고찰

Other Titles
 Clinical analysis of surgery of anterior communicating artery aneurysms 
Issue Date
1982
Description
의학과/석사
Abstract
[한글] 뇌동맥류의 수술에 수술현미경 및 미세수술 수기가 도입된 후 두개강내 직접수술이 유일한 치료방법으로 인정받고 있다. 전교통 동맥류는 정상 해부학적 구조의 변형이 많고, 동맥류의 돌출이 여러방향으로 향할 수 있으며, 동맥류의 파열 및 뇌동맥 연축시 발생되는 심각한 순환장애 및 시상하부등 중요구조의 손상, 치명적인 재출혈 등의 여러 문제점들로 완전한 수술적 치료가 특히 힘든것으로 알려져 있다. 1971년부터 1981년 8월까지 연세의대 신경외과학교실에서 수술적 가료를 받은 전교통동맥류 102예를 분석 고찰한 결과의 요약은 다음과 같다. 1. 총 102예중 남자가 60예, 여자가 46예 이었다. 40대가 37.2%로 가장 많았으며, 30대에서 50대가 전체의 81.7% 이었다. 2. 내원당시 주증상은 두통(98.6%)이 가장 많았고, 경부강직, 일과성 의식소실, 구토등의 순이었다. 3. 뇌동맥 조영상 prechiasmatic projection이 interhemispheric projection보다 많았다(43:39). 동맥류로의 조영제 유입은 좌측 전대뇌동맥이 55.9%, 우측이 33.3% 이었다. 뇌동맥 연축은 45.1%에서 관찰되었고, 다발성 동맥류의 빈도는 8.8% 이었다. 4. 뇌전산화단층촬영상 47.3%에서 지주막하출혈을 볼 수 있었고, 뇌수종 및 뇌연화의 출현 빈도는 각각 43.7%, 27.3%이었다. 직경이 1cm이상 되는 동맥류는 조영제 주사후 류의 증강을 보였고 거대 동맥류의 크기는 뇌전산화단층조영상으로 더 정확히 알 수 있었다. 5. 총 102예중 87예에서 수술현미경을 사용하여 미세혈관 수술을 시행하였으며, 이중 82.1%가 출혈후 2∼7주 사이에 수술받았고, 70.2%가 Botterell's Grade Ⅰ 및 Ⅱ에 해당되었다. 6. 수술현미경을 사용하여 수술한 87예는 모두 pterional approach로 수술을 하였고, 대부분 gyrus rectus 절개를 하였다. 동맥류 경부 ciipping은 82.1%에서 가능하였다. 7. 수술후 합병증은 뇌동맥 연축 14예, 두뇌강내 출혈 4예, 심한 전해질 이상 7예등이 가장 심각한 것으로 나타났고, 4명이 이 합병증으로 사망하였다. 8. 미세수술의 사망률은 4.8%, 이환율은 5.9% 이었다. 조기 파열된 9예의 수술 사망률은 11.1%이었다. 수술현미경을 사용하기 이전인 1975년 이전에 시행한 18예의 수술 사망률 및 이환율은 16.7%와 44.4% 이었다.
[영문] After the introduction of the surgical microscope, microsurgical direct intracranial approach became a standard technique for the treatment of ruptured intracranial aneurysms. Nevertheless, aneurysms of the anterior communicating artery present particular difficulties, because of their critical location, prevalence of local vascular anomalies, serious circulatory disturbances of the perforating vessels after the rupture of the aneusysm of vasospasm, and their marked tendency to fatal recurrent hemorrhage. The author analyzed 102 cases of anterior communicating artery aneurysms surgically treated in the Department of Neurosurgery, Yonsei University Hospital from 1971 through August 1981. Of the 102 cases, 84 operations were performed by microsurgical pterional approach. The analysis and evaluation was made with particular emphasis on the microsurgical treatment. The results of analysis were summarized as follows. 1. The anterior communicating artery aneurysms ruptured most frequently in the 5th decade(37.2%), and 81.7% of the patients were in their 30s to 50s. Anterior communicating artery aneurysms were more common in men than women (60:42). 2. Presenting symptoms and signs of rupture of the anterior communicating artery aneurysms were headache(98.6%), stiff neck(95.1%), brief lapse of consciousness(83.4%), vomiting(81.8%), hypertension(41.6%), and impaired conscious level(34.3%). 3. The prechiasmatic projection of the anterior communicating artery was slightly more frequent than the interhemispheric projection (43:39) in this series. The aneurysms were fed by the left anterior cerebral artery in 55.95 and by the right in 33.3%. Angiographic vasospasm was noted in 45.1% and the incidence of the multiple aneurysm was 8.8%. 4. The brain CT scan showed subarachnoid hemorrhage in 47.3%, hydrocephalus in 43.7%, and cerebral infarction in 27.3%. The aneurysms appeared as enhancing small lesions when the diameter of the aneurysm was largethan 10 mm. The actual size of the giant aneurysm was measured more precisely with the CT scan than by the angiogram. 5. Patient in Botterell's Grade Ⅰ and Ⅱ occupied 70.2% of the microsurgically treated cases. Majority of cases(82.1%) were operated in the second to fourth weeks after the last bleeding. 6. All of the 84 microsurgically treated cases were operated by the pterional approach, and the gyrus rectus resection was frequently performed. Clipping of the aneurysmal neck was possible in 82.1% of the series. 7. Fourteen cases of postoperative vasospasm, 4 cases of intracranial hematoma, and 7 cases of serious electrolyte imbalance were found as the major postoperative complications. Four patients died of these major complications. 8. Operative mortality of the microsurgical pterional approach was 4.8% and the morbidity, 5.9%. Mortality rate of 9 premature rupture cases was 11.1%. Among the 18 cases which were operated on without the aid of microscope before 1975, the motality rate was 16.7%, and the morbidity, 44.4%.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/116394
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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