手術アプローチ Ｌａｔｅｒａｌ ｓｕｐｒａｏｒｂｉｔａｌ ｋｅｙｈｏｌｅを用いた前交通動脈瘤のｃｌｉｐｐｉｎｇ術

Abstract

Clipping via keyhole surgery is one option for treating cerebral aneurysms. We have developed a lateral supraorbital keyhole approach to clip unruptured anterior communicating artery (ACom) aneurysms. This approach is a variant of the supraorbital keyhole approach, but extends the mini-craniotomy to the sphenoid ridge. The key point is epidural flattening of the bony spines on the orbital roof to provide an improved intradural surgical corridor. Thirty consecutive patients with unruptured ACom aneurysms were treated via the lateral supraorbital keyhole approach (maximum diameter: 30.9±3.6 mm, minimum diameter: 24.0±2.5 mm) without mortality or permanent morbidity. The aneurysm size was 3 to 11 mm (mean: 6.5±2.0 mm) and two-thirds of the aneurysm domes pointed anteriorly or inferiorly. Evaluation with Hasegawa’s dementia scale and the mini-mental scale examination did not detect any significant changes in the patients before or after surgery. The mean postoperative hospitalization period was 2.7±3.0 days. The lateral supraorbital keyhole approach is a safe surgical option to treat relatively small ACom aneurysms oriented anteriorly or inferiorly.