One-Stage Clipping of Bilateral Middle Cerebral Artery Aneurysms Via the Bilateral Pterional Keyhole Approach
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概要
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Five patients aged 55 to 73 years (mean 63 years) underwent one-stage clipping for unruptured aneurysms in the bilateral middle cerebral arteries (mean size 4.5 mm, range 2 to 7 mm) via the bilateral pterional keyhole approach in our institute. Important points are as follows: the head is affixed with no rotation; one side manipulation is started 5 minutes after the other side to avoid conflict of surgical instruments; a 5-cm curvilinear skin incision is made inside the hairline and pterional keyhole craniotomy is made bilaterally using 2 burr holes; the whole operating table is rotated 15 degrees to one side to facilitate the microsurgical trans-sylvian approach and aneurysm clipping; the operating table is rotated to the other side for the contralateral procedure; and particular care is taken to avoid bilateral brain injury. This approach provided minimum but sufficient working space required for trans-sylvian dissection. Aneurysm neck clipping was safely performed in a mean operation time of 5 hours 17 minutes. No complications occurred and satisfactory cosmetic results were obtained in all patients. Postoperative neuroimaging studies exhibited bilateral complete clipping with minimal intracranial air content and minimum consequences of brain retraction. One-stage clipping via the pterional keyhole approach is a safe and effective therapeutic option for small bilateral aneurysms.
著者
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SHIOKAWA Yoshiaki
Department of Neurosurgery, Kyorin University School of Medicine
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Noguchi Akio
Department Of Biomolecular Engineering Graduate School Of Engineering Tohoku University
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Shiokawa Yoshiaki
Department Of Neurosurgery Kyorin University School Of Medicine
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Maruyama Keisuke
Department of Biology, Faculty of Science, Toyama University
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KURITA Hiroki
Department of Cerebrovascular Surgery and Stroke Center, Saitama Medical University International Medical Center
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YAMAGUCHI Ryuichi
Department of Neurosurgery, Kyorin University School of Medicine
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