14. 後大脳動脈末稍動脈瘤の2例(その手術接近法について)

概要

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Two cases of aneurysms of the peripheral site of the posterior cerebral artery are reported, and the surgical approaches performed on them are also discussed.<BR>These patients underwent surgery by the subtemporal approach. Since the distance to the peripheral site of the posterior cerebral artery is long enough even with the subtemperal approach and the posterior site of the temporal lobe is located on the tentorium cerebelli, the temporal bone should be removed sufficiently and an operating microscope should be preliminarily prepared so that the focus can be adequately adjusted toward this side. In our two cases, however, it was necessary to sacrifice the Labbé's vein. (In one case, dysphasia appeared transitionally.) Because the posterior cerebral artery runs inside the hippocampal and the lingual gyri, it is often difficult to reach its peripheral site directly. For safety's sake also, it is more secure to pursue the peripheral site after confirming and securing the proximal part of the posterior cerebral artery with the removal of the cerebrospinal fluid. By this approach, it was necessary to remove a part of the hippocampal gyrus in the second case, but clipping could be accomplished without damaging the cranial nerves, penetrating branches from the posterior cerebral artery or the posterior choroidal arteries.
The Japanese Society on Surgery for Cerebral Strokeの論文