内頸動脈硬膜輪近傍動脈瘤に対するcombined epi- and subdural approach (Dolenc)

抄録

Between January 1990 and August 1991, 103 patients with intracranial aneurysms were admitted to our hospital and underwent microsurgical operations. Of the 103 patients, 6 had juxta DURAL-RING aneurysms. Kobayashi and his collaborators classify Juxta DURAL-RING aneurysms into 3 types: infraclinoid type, carotid cave type and intradural type. Of the present 6 cases, 3 cases were carotid cave type and 3 intradural type.
We applied Dolenc' pterional combined epi- and subdural approach to these aneurysms.
Surgical procedures are as follows: (1) a standard pterional craniotomy; (2) in the epidural approach, removal of the orbital roof together with the sphenoid wing, removal of the dorsal wall of the optic canal and the anterior clinoid process. Following these procedures, the anterior loop of the internal carotid artery (IC) can be traced through the thin membrane (Dolenc' anteromedial trangle); (3) in the subdural approach, complete opening of the dural ring, and the exposure of the surgical genu and axilla of the IC. (4) Utilizing these procedures, clipping is relatively easy with the use of Sugita's curved-blad ring (fenestrated) clip.
Postoperative carotid angiograms revealed that all 6 aneurysms were completely obliterated by the clips.
There were 2 complications: l is transient CSF leakage due to opening of the ethomoid sinus; the other is transient oculomotor nerve paresis presumably due to packing the oxycel into the cavernous sinus. All patients returned to their preoperative occupations without any neurological deficits.
From these results, we conclude that the pterional combined epi- and subdural approach is the procedure of choice for the juxta-Dural Ring aneurysms.