1. 前交通動脈瘤に対する右側からのPterional Approach

抄録

Operative techniques to the aneurysms of the anterior communicating artery are described. The steps I (S. W.) describe here have now been taught to my residents and staff and the methods of approach have been influenced by the requirements of teaching a logical method. The method may be followed safely and logically by the experienced surgeons. The right pterional approach has always been performed with only some situations of exception; (1) there is a significant intracerebral clot in the left frontal lobe, (2) there are multiple aneurysms on the left anterior circulation, and (3) there may be other complicating factors such as a previous right frontal craniotomy and others. Advantages of pterional approach from the right are; (1) mainly we are right-handed, (2) retraction of the nondominant frontal lobe is further advantage, and (3) craniotomy on the right, can be used for aneurysms with larger left A-1.
As Wilson and Spetzler said that if the patient's condition is optimal, the success of an operation depends primarily on the skill and experience of the surgeon and that an approach adopted by a master surgeon may be inappropriate for someone less experienced, there may be suitable methods, we believe, depending upon one's experience and technical standards.