Mid-lateral suboccipital approachによる椎骨動脈瘤トラッピング術─特にdistal endの攻略について─

抄録

The lateral suboccipital approach is a well-known method for trapping and clipping of a vertebral artery aneurysm (VA-AN). However, in this approach, the deeply situated cranial window and the lower cranial nerves (LCNs) crossing the operative field interfere with the procedure. Here, we describe our alternative mid-lateral suboccipital approach, with the surgical results in 16 recent patients.
Sixteen patients with VA-ANs were admitted to our institute from May 2012 to December 2013. Of these, 2 underwent endovascular treatment. The other 14, including 3 with large VA-ANs, underwent open surgery. These included 8 cases of unruptured and 6 of ruptured VA-ANs. The patients were placed in the prone position. J-shaped skin incisions were made and osteoplastic craniotomies were advanced to the condyle fossa, thus providing wide, superficial operative views.
Trapping was performed in 7 of 14 cases. Proximal clipping was performed in 3 cases and neck clipping in 3 cases.
In our method, the wide, superficial operative field enables the surgeon to apply clips to a high position VA-AN and distal VA from under the LCNs. The method also facilitates occipital artery (OA) avulsion for bypass surgery, if needed.
Thus, the mid-lateral suboccipital approach appears to be an effective alternative to the lateral suboccipital approach.