17. ウィリス輪前半部の脳動脈瘤に対する手術手技

概要

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Authors reported the simplified method of procedure for direct aneurysmal surgery at anterior circle of Willis.<BR>Simplified method: On operating table, the patient's head was turned to the healthy side at an angle of 45 degrees to a horizontal line. Linear scalp incision was made as seen in Fig. 1 and temporal muscles were also incised by straight fashion. Wound was retracted by two Gelpi retractors, and two key burr holes were perforated at the site of subpterion (on the spheno-squamous suture) and the site of ca 1cm postero-superior portion from fronto-zygomatico-sphenoidal junction (the site between Linea temporalis and spheno-frontal suture). The small craniotomy was done and a ca 3cm×4cm oval-shaped skull flap was removed till the time of closure. When dura was reflected, superficial Sylvian veins were seen at the center of the operative field. Then, aneurysmal neck exposure was begun. After the aneurysmal neck clipping was completed, dura was sutured and few suspending sutures and tenting suture were done. Drain at subdural or epidural space was not set up.<BR>Results: Thirty aneurysmal patients of chronic stage were treated by this simplified method, and most shortest operating time was 80 minutes of internal carotid artery (IC-PC) aneurysm. There were no significant troubles or complications produced by this method.