内頚動脈先端部より高位の内頚動脈-後交通動脈分岐部動脈瘤に対するクリッピング術─2症例報告─

抄録

We report two cases of internal carotid-posterior communicating artery aneurysm (IC-PC AN) located above the IC bifurcation. The first case was a 51-year-old woman with subarachnoid hemorrhage (SAH) caused by a ruptured high-lying IC-PC AN projecting superiorly. The aneurysm was behind the arteries and perforators completely in the pterional transsylvian route; therefore, the clip was applied from the carotid-optic triangle confirming the blade tip of the clip through the supracarotid triangle. The second case was an 81-year-old man with SAH because of a ruptured high-lying IC-PC AN projecting posteriorly. The aneurysm was obscured by arteries and the temporal lobe in the pterional transsylvian route, so was visualized and clipped by retracting the arterial structures and temporal lobe, similar to an anterior temporal approach.
IC-PC ANs above the IC bifurcation are located behind the surrounding structures in the operative field. Therefore, selection of the proper approach according to the anatomical location of the IC-PC AN and effective utilization of the space around the IC as the surgical window are important in such cases.