Traynelis V C, Dunker R O
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City.
J Neurosurg. 1992 Sep;77(3):481-3. doi: 10.3171/jns.1992.77.3.0481.
Distal anterior cerebral artery aneurysms are commonly found near the genu of the corpus callosum. While these aneurysms may be surgically obliterated through a variety of approaches, exposure via the interhemispheric fissure is used by many surgeons. Early identification of the afferent artery may be difficult with this approach, however, particularly if the aneurysm lies just beneath the genu of the corpus callosum. The authors have modified the interhemispheric approach to distal anterior cerebral artery aneurysms by electively exposing the feeding artery through a small anterior callosotomy. While this maneuver is not necessary for all distal anterior cerebral artery aneurysms, it can greatly enhance exposure in the region just below the genu of the corpus callosum. Experience with this technique in five patients is reported. In all cases, the limited anterior callosotomy enhanced surgical exposure. No morbidity could be attributed to the callosotomy in any patient. It is concluded that, when the interhemispheric approach is used, anterior callosotomy improves exposure of the region just below the genu of the corpus callosum and may be a useful maneuver when treating distal anterior cerebral artery aneurysms.
大脑前动脉远端动脉瘤常见于胼胝体膝部附近。虽然这些动脉瘤可通过多种方法进行手术夹闭，但许多外科医生采用经纵裂入路进行显露。然而，采用这种入路时，早期识别供血动脉可能较为困难，尤其是当动脉瘤恰好位于胼胝体膝部下方时。作者通过选择性地经小胼胝体前部切开术显露供血动脉，对大脑前动脉远端动脉瘤的经纵裂入路进行了改良。虽然这种操作并非对所有大脑前动脉远端动脉瘤都必需，但它可极大地改善胼胝体膝部下方区域的显露。本文报告了5例应用该技术的经验。在所有病例中，有限的胼胝体前部切开术均增强了手术显露。没有任何患者的并发症可归因于胼胝体切开术。结论是，当采用经纵裂入路时，胼胝体前部切开术可改善胼胝体膝部下方区域的显露，在治疗大脑前动脉远端动脉瘤时可能是一种有用的操作。
