抄録
Of 113 patients with cerebral aneurysms undergoing surgery by direct approach at our hospital from May 1981 to April 1983, seven cases with carotid-ophthalmic aneurysms were examined mainly for the surgical procedures.
As regards the two cases with the Kothandaram's suprachiasmal type, there were no problems with the procedures. The five cases with the subchiasmal type underwent the surgery by the ipsilateral pterional approach. All the patients required unroofing by means of a microsurgical drill for the sake of security of the neck of the aneurysms. In three of the five cases, clipping could be performed, but not in the other two.
The problem of whether the neck of an aneurysm is easily secured or not should be discussed from various viewpoints, such as the position of the neck, size of the aneurysms and positional relationships between the aneurysms and the ophthalmic artery and/or the anterior clinoid process, etc. Even so, it is difficult to define the problem with certainty. But it is our impression that the anterior clinoid process was revealed as coming over the C2 portion of the internal carotid artery and a small angle between C2 and C4 portion, that is, the strong refraction posteriorly centering the C3 portion angiographically suggest that the operational field was unfavourable.
