Inoue Akihiro, Kohno Kanehisa, Takeda Tetsuji, Takechi Akihiko, Kohno Keiji, Yamaguchi Yoshiaki, Ishii Daizo, Sasaki Ushio
Department of Neurosurgery, Ehime Prefectural Central Hospital, Kasugamachi 83, Matsuyama-shi, Ehime 790-0024, Japan.
No Shinkei Geka. 2006 Apr;34(4):421-6.
A 59-year-old female was found to be drawn in a swimming pool and transferred to our hospital. The patient was comatose on admission (Hunt & Kosnk: Grade IV). Computed tomography (CT) showed diffuse subarachnoid hemorrhage (SAH) with thick hematoma in the left ambient cistern. Conventional cerebral angiography and 3D-digital subtraction angiography revealed aneurysms (ANs) of the left posterior cerebral artery (P2), and bifurcation of the left internal carotid and posterior communicating arteries (IC-PC). Successful neck clipping was performed the same day through the temporal horn via the insula for ruptured P2 AN, and the non-ruptured IC-PC AN was also obliterated using a pterional approach. Postoperative course was uneventful except for initial disturbance of consciousness and aphasia. The patient was discharged with no neurological deficit 1 month after surgery. This approach may be preferable in cases involving high positioned PCA AN in the ambient cistern, particularly in the acute phase of severe SAH, as the brain is protected from the detrimental effects of strong temporal retraction and a wider working space is provided.
一名59岁女性被发现溺于游泳池，随后被转送至我院。患者入院时昏迷（Hunt & Kosnk分级：IV级）。计算机断层扫描（CT）显示弥漫性蛛网膜下腔出血（SAH），左侧环池有厚血肿。传统脑血管造影和三维数字减影血管造影显示左侧大脑后动脉（P2）以及左侧颈内动脉与后交通动脉分叉处（IC-PC）存在动脉瘤（ANs）。当天通过颞角经岛叶对破裂的P2动脉瘤成功实施了夹闭术，对于未破裂的IC-PC动脉瘤则采用翼点入路予以消除。术后除最初的意识障碍和失语外，病程平稳。患者术后1个月出院，无神经功能缺损。对于环池内高位大脑后动脉动脉瘤的病例，尤其是在严重SAH的急性期，这种入路可能更可取，因为可使大脑免受强力颞叶牵拉的有害影响，并提供更广阔的操作空间。
