Abstract
In cerebral aneurysm surgery, an effort to reduce an operative risk, furthermore, must be continued generously. With that purpose, the possibility that various complications occur must be assumed always.
Perforating artery injuries can occur due to failure to recognize clip co-occlusion, or kinking at its origin, or pulling it up, and so on. Therefore, it is very important for the operator to observe well and to adequately exfoliate in order to prevent these troubles. A technique where by the dissecting manipulation can be completed safely is also needed.
Clip insertion in a free direction and the delicate adjustment of the clipping line are necessary to avoid a stenosis of the a parent artery or branching artery by clipping. At the same time, it is important to obtain sufficient mobility of the aneurysm and the branching arteries. This mobility leads to both good visibility and safe operation. A large surgical field realizes a free visual axis and an adequate manipulation angle. Thorough dissection without compromise leads to a safe and successful outcome. It is also important to preserve all veins as much as possible by denuding to avoid venous infarction or hemorrhage.
In a complicated aneurysm such as a large sized or sclerotic aneurysm, a conbined procedure including an arterial bypass should be selected. In this type of bypass combined surgery, intraoperative measurement of the arterial blood flow using a transit-time flowmeter will be very useful.
