Kobayashi M, Suzuki M, Sato N, Omama S, Otawara Y, Wada T, Ogawa A
Department of Neurosurgery, Iwate Medical University, Japan.
No Shinkei Geka. 1999 Jul;27(7):639-43.
The authors reported an operated case with an aneurysm arising from the proximal end of basilar artery fenestration, and discussed its etiology and surgical strategy. A 47-year-old woman presented with slight memory disturbance. Neuroradiologic examination revealed an aneurysm located on the proximal end of the basilar artery 12 x 9 mm in size at the level of the outer auditory meatus. The union of vertebral arteries had deviated toward the right side, and the aneurysmal dome had projected into the fenestration. Through the right far lateral approach, we applied two straight fenestrated clips X configuration to the aneurysm. Several authors have reported a variety of approaches for vertebrobasilar aneurysms along the midline with consideration of the height of the aneurysmal. However, another point of view is that attention should be paid to the direction of the clip blade and applied at the final clipping, because, for vertebrobasilar aneurysms adjacent to the midline, the surgical view and working space are extremely restricted.
作者报告了一例基底动脉开窗近端出现动脉瘤的手术病例,并讨论了其病因及手术策略。一名47岁女性出现轻微记忆障碍。神经放射学检查显示,在外耳道水平,基底动脉近端有一个大小为12×9mm的动脉瘤。椎动脉汇合处偏向右侧,动脉瘤瘤顶突入开窗处。通过右侧远外侧入路,我们对动脉瘤应用了两个呈X形配置的直形开窗夹。几位作者报告了多种沿中线处理椎基底动脉瘤的方法,并考虑了动脉瘤的高度。然而,另一种观点是,在最终夹闭时应注意夹片的方向并加以应用,因为对于邻近中线的椎基底动脉瘤,手术视野和操作空间极其受限。