64. VA-PICA aneurysmへの接近法における工夫

概要

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Sixteen patients with VA-PICA aneurysm were treated in our department from 1965 to 1982_Direct approach to the aneurysm was carried out in 11 cases out of 16 (Table 1). We encountered difficulties in access to the aneurysm in 5 cases (case 2, 4, 6, 13, 15) and in clipping procedures in 4 cases (case 6, 7, 10, 15 ). These difficulties found in operation were evaluated in relation to angiographical findings. The aneurysms located between 0 to 5 mm from the midline or more than 21 mm from the lateral point of the foramen magnum (Fig. 2) could be reached with difficulty through unilateral suboccipital craniotomy (Fig. 3). The aneurysms with the dome directed posteriorly had to be treated carefully because of their possible adhesion to or invagination into the medulla oblongata. The aneurysms with the dome directed medially were difficult to be clipped because they exist on the opposite side of the vertebral artery. <BR>In our experience, it is found very useful in such aneurysms as the dome directed medially or the distal vertebral artery running medially to move the vertebral artery ventrally by dissecting perforators. The peripheral vertebral artery to the aneurysm, contralateral vertebral artery and initial portion of the basilar artery can be identified through the space between medulla oblongata and the vertebral artery, which can be called "medulla oblongata-vertebral triangle (Fig. 4)".
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