Management of Multiple Cerebral Aneurysms with Unilateral Pterional Approach:Its Possibilities and Limitations
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A patient is placed in the semi-Fowler's position, the upper body is elevated 15 degrees and the lower is also elevated 10 degrees from a supine position. The head is fixed with a three-point skull fixation device after being rotated 45 degrees toward the contralateral side.<BR>This head position makes it easy to reach the Willis ring along the sphenoidal ridge with minimum retraction of the brain.<BR>Most aneurysms are found on the main vessels around the Willis ring; looking at the main vessels from the same angle, and dissecting the vessels and the aneurysm in the same direction, one will have better orientation and surgical techniques.<BR>Aneurysms around the Willis ring, including basilar top aneurysm and middle cerebral artery aneurysms, are operated on in the same position and through the same pterional approach.<BR>In addition, neck clipping may be possible even in some contralateral aneurysms with an uilateral pterional approach.<BR>This unilateral pterional approach is especially beneficial in treating cases of multiple aneurysms.<BR>Over one half of all contralateral IC aneurysms and about one third of all contralateral MC aneurysms can be clipped with a unilateral pterional approach.<BR>A contralateral anterior choroidal artery aneurysm cannot be clipped because it is hidden behind the optic chiasma.<BR>In handling a basilar top aneurysm, it is rather easy when the length of the IC to the bifurcation of A<SUB>1</SUB> and M<SUB>1</SUB> is long enough, but it is difficult when the IC is arteriosclerotic and not movable, because the space for surgical maneuver is too narrow.
- The Japanese Society on Surgery for Cerebral Strokeの論文
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- Management of Multiple Cerebral Aneurysms with Unilateral Pterional Approach:Its Possibilities and Limitations