48. 脳動脈瘤手術における柄部形成術

抄録

The “neck making technique” with bipolar coagulation in the clipping of the aneurysm is described. This technique is very useful, to make safe preparation for the neck clipping, or to obtain the “best point of clipping”.
In dissecting the aneurysm from adjacent structures, the forceps of a bipolar coagulator is attached parallel to the wall of the aneurysm and coagulation is done at this position. The coagulated wall of the aneurysm is shrunken and a small space is made between the aneurysm and the adjacent structures. Through this space, further dissection and the coagulation is performed to make the “neck” of the aneurysm.
If the reverse side of the aneurysm can be observed directly by this procedure, the “neck” can then be clipped. If it is difficult to reach, or the perforators can not be spared in clipping, the size of the aneurysm should be reduced by cutting the dome, then the “neck making” is performed to make the “best point” of clipping.