前大脳動脈末梢部動脈瘤の手術アプローチに関する検討

抄録

Distal anterior cerebral artery aneurysms (DACA-ANs) are relatively uncommon and lead to some unique operative difficulties. We retrospectively reviewed 18 cases of DACA-ANs, treated in our institute between April 2007 and October 2013, with regard to anatomical features and surgical approaches. DACA-ANs were categorized into three groups: infra-, anterior-, and supra-genu types, based on their anatomical relationship with the genu of the corpus callosum.
The most common location was the bifurcation of the pericallosal and callosomarginal arteries (50%). DACA-ANs were infra- in 5, anterior- in 11, and supra- genu in 2 cases. The interhemispheric approach (IHA) was selected in all cases except in one. DACA-ANs were clipped via the basal, anterior, and superior IHA in 5, 11, and 1 cases, respectively. Selection of microsurgical trajectory to the aneurysm based on the anatomical architecture of the ACA and genu of the corpus callosum is vital to occlude aneurysms safely with proximal control established.