中大脳動脈瘤,内頸動脈瘤に対する distal trans-Sylvian approach

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Microsurgery for cerebral aneurysms has been commonly practiced in recent years, and various microsurgical procedures are reported by several authors."Distal trans-Sylvian approach (D. T. S.)"for middle cerebral (MC) and internal carotid (IC) artery aneurysms, may be taken not only in our institute but in many others. But, concerning with D. T. S. for MC-AN, that for IC-AN is not commonly accepted compaired with front-basal approach (F. B.). In this paper, authors explained the actual operative procedures of D. T. S. and attempted to clarify the advantages and the disadvantages of D. T. S. compared with F. B.. The advantages are as follows: 1) Brain retraction in this approach is less than F. B.. 2) We can get all components of the parent artery, the aneurysm and the others inspite of more narrow and slitlike operative field compaired with F. B.. Especially in the cases of internal carotid artery aneurysm, this operative field corresponds to the course of supraclinoid portion of internal carotid artery. 3) Clot in the Sylvian fissure may be evacuated easily. 4) It is not necessary to extend the craniotomy to the skull base. The disadvantages are as follows: 1) Rude operative procedures may injure Sylvian vein and the surrounding structures to cause more serious brain damage. 2) Various kinds of aneurysmal clips may be needed in this slitlike operative field. 3) Aneurysmal fundus may appear before confirming its neck and parent artery in some cases.
The Japanese Society on Surgery for Cerebral Strokeの論文

中大脳動脈瘤,内頸動脈瘤に対する distal trans-Sylvian approach

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