16. 脳動脈瘤手術のapproach

概要

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Four hundreds thirty nine cases of direct operations on intracranial aneurysms have been performed since April 1973 by myself. Sylvian fissure must be opened very superficially to start with. The widest part of the Sylvian fissure should be identified and separated. Since the MC trifurcation is located in the widest portion of the Sylvian fissure, the aneurysms of the MC trifurcation could be reached smoothly by this method. Gyrus Rectus or interhemispheric approach is better if the anterior communicating artery is located more than 1.5cm, above the frontal base. When the anterior communicating artery aneu-aneurysm is pointing downwards, A2-Acom is to he considered in the approach. When the rysm is pointing superiorly "U" of A1 dominancy is to be considered. Separation of the aneurysm should be done from the neck of the aneurysm. The technique of dome coagulation has to be use sometimes. The permanent clipping of the neck of the aneurysm should be done only after complete delination and confirmation of the aneurysm.