未破裂前交通動脈瘤に対するInterhemispheric approachの治療成績

Abstract

There are two surgical approaches to anterior communicating artery aneurysms: the pterional approach and the interhemispheric approach. We have performed the interhemispheric approach for all cases of anterior communicating artery aneurysms because it is possible to obtain a wide operative field and to confirm the anatomical structure of the anterior communicating artery complex. It is relatively easier in interhemispheric approach to confirm and preserve the hypothalamic arteries arising from Acom complex, even in a superior or posterior projecting aneurysm. We reviewed the interhemispheric approach for the unruptured anterior communicating artery aneurysms between 1996 and 2007 in our institution and analyzed complications in 47 cases. Complete obliteration of the aneurysm was confirmed in all 47 cases during at least three years after operation. Diffusion-weighted MRI imaging disclosed ischemic lesions in one patient. Symptomatic epilepsy resulted in one patient from a right frontal lobe contusion. The other complications were anosmia in two cases and liquorrhea in one case. Based on our experience, we improved the interhemispheric approach. We have not experienced cases of the complication since 2008. We describe the problems and technical points of the interhemispheric approach for anterior communicating artery aneurysms.