破裂前交通動脈瘤に対するpterional approachとinterhemispheric approachの比較

Abstract

From 1990 to 1993, 56 cases of ruptured anterior communicating artery aneurysms were operated on in an acute stage through the Pterional (PT) approach or the Interhemispheric (IH) approach. In this series, the PT approach was used in 33 cases (PT group), and the IH approach in 23 cases (IH group). We evaluated the surgical complications of these 2 surgical groups retrospectively.Injury of perforating artery occurred more often in the PT group, and was caused mainly by improper brain retraction or temporary occlusion of the parent artery. In most of these cases, the aneurysms projected laterally or superiorly and the operation was carried out at the side of the A2 running anteriorly.On the other hand, symptomatic vasospasm was observed more frequently in the IH group. In these cases, the methods for prevention of symptomatic vasospasm were insufficient.These results indicate that in the PT approach, it is very important to assess the projection of aneurysm, and the anatomical relationship between the aneurysm and the surrounding vascular structure preoperatively, and to decide the approach side in consideration of the posteriority of the A2 segment. While, in the IH approach, great care should be taken to prevent vasospasm.