穿通枝温存の観点からみた脳動脈瘤クリッピング術の手術手技

概要

論文の詳細を見る
A devastating complication after surgical clipping for intracranial aneurysms is neurological deficits caused by blood flow insufficiency of perforating arteries. To preserve blood flow of perforators, surgeons must identify all perforators around aneurysms. When a perforator adheres to aneurysmal walls, it should be dissected from the aneurysms as far as possible. When a perforator originates at an aneurysmal neck or dome, a clip must be placed with shaping the origin of the perforator. After clipping, the patency of perforators are confirmed by Doppler ultrasonography, indocyanine green (ICG) videoangiography and motor-evoked potential (MEP) monitoring. The above-mentioned meticulous surgical maneuver can minimize the risk of cerebral infarction due to the occlusion of perforators and improve surgical outcomes after aneurysmal clipping.