Pterional approachにおける静脈処理の問題点

Abstract

It is often unavoidable to cut the bridging veins via the frontal base to the superficial sylvian vein (fronto-temporal bridging vein, FTBV) in the pterional approach to the cerebral aneurysms and complications rarely occur. We analyzed approximately 300 cases who underwent the pterional approach over the past 5 years retrospectively, by intraoperative VTR and postoperative CT scan of each case. Eight cases (2.6%) had changes that were considered to be the venous system-related infarction, excluding retraction injury (43 to 78 years old, mean 58; IC-PC: 6 cases; Acomm.: 1 case; basilar tip: 1 case). The area of venous infarction ranges from ipsilateral deep frontal white matter to the basal ganglia, which was presumed to be the area of a first segment of basal vein of Rosenthal. Two of the 8 cases produced intracerebral hematoma in a basal ganglia, one died from pneumonia and heart failure 1 month later, and temporary motor aphasia was observed in the other one. The remaining 6 patients showed an uneventful course or a transient mild disorientation. We reviewed anatomical variations of cerebral veins and presumed that FTBV in those cases could be anastomotic veins of superficial and deep venous drainage system. We discuss some methods of preventing such complications.