Ｂａｓａｌ ｉｎｔｅｒｈｅｍｉｓｐｈｅｒｉｃ ａｐｐｒｏａｃｈにおける大脳半球間裂剥離のトレーニング―レジデントが陥る軟膜損傷のパターンとその対策―

Abstract

Dissection of the interhemispheric fissure via a basal interhemispheric approach (BIHA) is one of the most difficult skills for young neurosurgeons to acquire. We reviewed operative videos of 30 BIHAs performed by 4 residents in our institute, and investigated how the pia mater or pial capillary vessels were injured. Furthermore, after comparing these procedures with those of senior neurosurgeons in our institute, we discussed factors causing injury of the pia mater or pial capillary vessels and effective remedies to improve skills. As a result, causes of pial injury were roughly divisible into 3 types: microscissor problems; excessive tension on trabecullae; and inappropriate hemostatic technique. Learning the transformation of the interhemispheric fissure accompanying cerebrospinal fluid decreases and the anatomical characteristics of interhemispheric fissure is important for acquiring appropriate brain retraction. Training to find trabecullae to be cut in the narrow microsurgical field is also an important skill to acquire for BIHA.