椎骨動脈瘤に対する顆窩経由法における開閉頭時の留意点

抄録

Specific clipping for the treatment of a cerebral aneurysm is accomplished through a wide operative field. This is obtained through both full exposure and lateral exclusion of the sigmoid sinus; however, these increase the risk of either sigmoid sinus injury or occlusion. Here, we developed a transcondylar fossa approach with standardized procedures to improve surgical safety. Furthermore, we retrospectively analyzed the procedural outcomes. The most important steps of our approach include the following: layer-by-layer dissection of the suboccipital muscles, pealing of the emissary vein, exposure of the sigmoid sinus, opening of the dura, and closure of both the dura and mastoid air cell. A total of 12 patients underwent the mentioned transcondylar fossa approach for vertebral aneurysm treatment between 2014 and 2018. All aneurysms were successfully treated with our obliteration approach after surgery. However, one patient experienced sigmoid sinus occlusion as a result of excessive fat filling, which was associated with the closure of the mastoid air cells. In conclusion, our standardized procedures support safe clipping of vertebral artery aneurysms.