11. 中大脳動脈瘤に対する接近法: 正中位での Approach

概要

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Thirty-seven consecutive patients with aneurysm of the middle cerebral artery were operated on between October, 1980 and December, 1982. All of them were operated in the neutral and slightly chin up position of the head. Thirteen of 37 patients associated with multiple aneurysm and were operated at the same time. The our standard approach is a medium-sized frontotemporal craniotomy. As a rule the sylvian fissure is split from proximally to distally after the chiasmatic and carotid cisterns are opened. The dissection proceeds more deeply to identify the trunk of the middle cerebral artery before dissection of the aneurysm, and then the neck of aneurysm is dissected safely. We emphasize that the merits of the neutral position of the head are as follows; (1) the parent artery can be dissected initially and easily, and (2) if bilateral craniotomies are necessary in cases of multiple aneurysm, they are performed easily to treat aneurysms without change of patient's position at one stage.
The Japanese Society on Surgery for Cerebral Strokeの論文