61. 椎骨動脈・後下小脳動脈分岐部動脈瘤の手術経験

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Two cases of vertebral aneurysm at the origin of PICA were operated on at the Department of Neurosurgery, School of Medicine, University of Kanazawa at 1982. Two patients could work and led normal family lives postoperatively. <BR>The posterior fossa was exposed with the Nap position by using a hemioccipital incision and a left suboccipital craniotomy. It was important to remove the lateral side of the occipital bone closely adjacent to the sigmoid sinus, the base of the occipital bone and the hemi-arch of the atlas so that the exposure could be low enough. The dura was opened and the arachnoid was opened over the foramen magnum. The cerebellar hemisphere was gently elevated by using the brain retractors. The arachnoidal opening was enlarged toward the lateral gutter. The highest dentate ligament was identified, transected. This permit exposure of the vertebral atery as it enters the dura. The vertebral artery was followed rostrally. The IX, X and XI cranial nerves were encountered as they lay stretched over the PICA aneurysm. The dome of aneurysm of case 1 was closely adherent to medulla. These nerves were separated from the aneurysm using a fine nerve hook. The neck of aneurysm was clipped by Sugita clip. Surgical complications noted were left hypoglossal nerve palsy for a month. In second case, the aneurysm were mounted the postero-lateral hemisphere, and therefor partial removal of cerebellum was performed. After the aneurysm had been completely exposed, the neck of aneurysm was amenable to clipping of its neck.
The Japanese Society on Surgery for Cerebral Strokeの論文

61. 椎骨動脈・後下小脳動脈分岐部動脈瘤の手術経験

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