44. 脳動脈瘤手術における2～3の工夫

抄録

312 cases of direct surgery for intracranial aneurysms were experienced in our service for last 5 years. It is the purpose of this paper to introduce some of our intraoperative technique which have been successfully applied for.
1) Management of premature rupture of aneurysm around the neck It has been recommended that muscle piece with Alon-Alpha adhesives should be applied to the ruptured orfice for hemostasis. However, this technique did not work well in many cases in such a time of crisis. In our successfully treated cases, temporary clips were placed on both distal and proximal side to the aneurysm as the first step. A piece of small oxycell ball were inserted into the ruptured orfice and obstructed it, then a Heifetz clip was placed on the neck including the ruptured orfice. After this clipping, temporary clips were removed. When hemostasis was confirmed, Biobond adhesive was dripped over for securing the clip in place.
2) Management of unruptured doughter aneurysms around the neck These daughter aneurysm around the neck have hazards to occur rupture at the time of the neck clipping of the parent aneurysm. Therefore, bipolar coagulation should be proceeded with weak power before the clipping. We experienced such small doughter aneurysms quite oftenly disappeared by bipolar coagulation.
3) Dissection of the posterior communicating artery In the pterional approach to the basilar head aneurysm, the posterior communicating arteries bothers operative field for manipulating the neck of aneurysm in some occasion. If preoperative angiographical studies indicate well developed open Willis circle, we may cut in the middle of the posterior communicating artery without any complication. Cutting of the artery should be done by use of small clip application. Bipolar coagulation and injuries of the perforators should carefully be avoided.
By this procedure, the operative field will be widered and it facilitate dissection of the neck and applicaiton of the clipping forceps much easier.