手術アプローチ 末梢性前大脳動脈瘤に対する手術アプローチ―Ｈｏｒｉｚｏｎｔａｌ ｈｅａｄ ｐｏｓｉｔｉｏｎを用いたｄｉｓｔａｌ ａｐｐｒｏａｃｈの有用性―

Abstract

We evaluated the applicability of the interhemispheric approach to the A3-4 segment of distal anterior cerebral artery (dACA) aneurysm with a horizontal head position. Between April 2006 and August 2009, we had 6 cases with a dACA aneurysm and performed neck clipping. The patient’s head was placed horizontally, usually with the left side up. A parasagittal craniotomy on the right side that crossed the midline and exposed the superior sagittal sinus was performed. The pericallosal artery in the corpus callosum cistern was exposed and proximally traced to the neck of the aneurysm. The exploration of the A2 segment for proximal control was accomplished just anterior to the genu of corpus callosum. All aneurysms were clipped successfully. There was no surgical mortality or morbidity. The horizontal head position permits gravity to retract the downside hemisphere and open the interhemispheric fissure while the falx retracts the upside hemisphere. The interhemispheric approach with horizontal head position can be used to treat dACA aneurysm safely and successfully.