脳動脈瘤手術への頭蓋底手術の応用

Abstract

Cerebral aneurysm in the anterior cirulation has been treated with standard approaches, such as the pterional approach and interhemispheric approach.These approaches have provided sufficient surgical results in cases with aneurysms of usual location and of small to moderate size. However, we have experienced some difficulties in cases with unusual location and large size.For these difficult and complicated cases, we employed skull base approaches, including Dolenc's extra-and intradural approach (DEIA), orbitozygomatic transsylvian approach (OZTSA) and basal interhemispheric approach (BIHA).With these skull base approaches, we treated 28 cases of anterior circulation aneurysm; 5 cases of high positioned, posteriorly projected AcomA aneurysm; 7 of proximal ICA aneurysm: and 16 of multiple, bilateral aneurysm.Complications related to the approaches included two visual impairments caused by insufficient unroofing of the optic canal, and one CSF leakage that was resolved with treatment.Skull base approaches, if used selectively, can provide good exposure of high positioned aneurysms and large or giant aneurysms without brain retraction, which may cause brain damage.