前交通動脈瘤の解剖学的特徴をもとにした手術法の選択と手術手技(<特集>前交通動脈動脈瘤の手術手技 : 穿通枝温存)

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Neurosurgeons have 2 established approaches for the anterior communicating artery aneurysm (ACoAn): pterional (PT) and interhemispheric (IH). To elucidate which approach best suits various types of ACoAn, we studied angiograms from 202 consecutive operated cases. ACoAn can be classified into 4 groups by the direction of neck protrusion: anterior/inferior (AI: 43%), superior (SUP: 23%), posterior/superior (POST: 2%) and lateral (LAT: 32%). The LAT type is a peculiar aneurysm defined as protruding its neck and the dome sideways contralateral to the dominant Al. It is hard to recognize this type well on lateral projection angiogram because its neck and the dome are superimposed on the A1-A2 corner that the aneurysm arises from. In LAT, the dominant Al is overwhelmingly on the left side (73.8%), while in the other types, the left Al predominance is not observed (the left Al dominant in 31.4%, the right Al dominant in 32.8% and epui-Al in 35.8%). Ninety percent of AI were operated on by PT. For the SUP type, both PT (48%) and IH (41%) were employed, depending on the size and shape of the dome and height of the neck from the frontal base. The LAT and POST type were clipped safely by IH (75.4 and 75.0%, respectively). Though LAT can be clipped by PT from the side of the neck protrusion getting over the dome (16%), this is apparently more difficult and risky than by IH. We present typical cases operated on both by PT or IH in each ACoAn type with annotations concerning surgical indications and techniques.
日本脳卒中の外科学会の論文
2002-07-31

前交通動脈瘤の解剖学的特徴をもとにした手術法の選択と手術手技(<特集>前交通動脈動脈瘤の手術手技 : 穿通枝温存)

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