60. 脳底動脈の動脈瘤に対する手術法の検討:-Trans-sylvian approach-

概要

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The accumulated cases of the vertebro-basilar aneurysms are now 162 and the number of aneurysms are 167. Among them, the Basilar-bifurcation (BA-BIF ), basilar-superior cerebellar (BA-SCA), basilar-anterior inferior cerebellar (BA-AICA) aneurysms and aneurysms from P1 portion are considered to be potentially indicated for trans-sylvian approach. Those account for approximately 60% of the whole cases. Variety of anatomical structure: 1) Internal carotid artery (ICA): The length and the curvature of ICA are important factors. The longer ICA without an atheroma is easier in retraction and the one with lateralconvex curvature is difficult. 2) Anterior cerebral artery (ACA): The long and redundant At may offer an opportunity of approach through the space between ICA and the optical nerve. Clipping through this space is rarely possible (only two cases), but observation of the opposite Pi through this space is useful. 3) Posterior communicating artery (P. COMM. A.): For BA-SCA aneurysm, P. COMM. A. is lifted upward to make a sufficient space for clipping and for BA-BIF aneurysms, especially when located high, a space medial to P. COMM. A. should be made through its perforators. 4) Oculomotor nerve: The arachnoid should be sut only medial to the nerve. The nerve will be spontaneously displased laterally beneath the tentorium.
The Japanese Society on Surgery for Cerebral Strokeの論文