未破裂脳動脈瘤に対するＯｖｅｒｎｉｇｈｔ手術を目標としたＫｅｙｈｏｌｅ ｃｌｉｐｐｉｎｇ術の開発

Abstract

Forty-eight patients with 52 unruptured aneurysms were treated by 50 keyhole clipping procedures. The 32 middle cerebral artery aneurysms were treated through the pterional keyhole approach using an outer canthal skin incision. The 16 internal carotid artery aneurysms and 4 anterior communicating artery aneurysms were treated through supraorbital keyhole craniotomy via an eyebrow skin incision (Perneczky method). Preoperative three-dimensional computed tomography angiography with the osteotomy technique was used to determine the best location and size for the keyhole in each patient. No scalp hair shaving, drainage placement, or anti-convulsant medication were needed. The mean sizes of the pterional and supraorbital keyholes were 25×23 mm and 29×21 mm, respectively. The outcomes on the modified Rankin Scale were Grade 0 in 46 cases, Grade 1 in 3 cases with frontalis muscle weakness, and Grade 3 in 1 case with lacunar infarction. Most of the patients were discharged on the 2nd or 3rd postoperative day. Keyhole clipping surgery is another treatment option for relatively small unruptured anterior circulation aneurysms and may require only overnight hospitalization.