Maruyama Keisuke, Kurita Hiroki, Yamaguchi Ryuichi, Noguchi Akio, Shiokawa Yoshiaki
Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2013;53(3):148-52. doi: 10.2176/nmc.53.148.
Five patients aged 55 to 73 years (mean 63 years) underwent one-stage clipping for unruptured aneurysms in the bilateral middle cerebral arteries (mean size 4.5 mm, range 2 to 7 mm) via the bilateral pterional keyhole approach in our institute. Important points are as follows: the head is affixed with no rotation; one side manipulation is started 5 minutes after the other side to avoid conflict of surgical instruments; a 5-cm curvilinear skin incision is made inside the hairline and pterional keyhole craniotomy is made bilaterally using 2 burr holes; the whole operating table is rotated 15 degrees to one side to facilitate the microsurgical trans-sylvian approach and aneurysm clipping; the operating table is rotated to the other side for the contralateral procedure; and particular care is taken to avoid bilateral brain injury. This approach provided minimum but sufficient working space required for trans-sylvian dissection. Aneurysm neck clipping was safely performed in a mean operation time of 5 hours 17 minutes. No complications occurred and satisfactory cosmetic results were obtained in all patients. Postoperative neuroimaging studies exhibited bilateral complete clipping with minimal intracranial air content and minimum consequences of brain retraction. One-stage clipping via the pterional keyhole approach is a safe and effective therapeutic option for small bilateral aneurysms.
在我们研究所，5例年龄在55至73岁（平均63岁）的患者通过双侧翼点锁孔入路，对双侧大脑中动脉未破裂动脉瘤（平均大小4.5mm，范围2至7mm）进行了一期夹闭。要点如下：头部固定无旋转；一侧操作在另一侧开始5分钟后进行，以避免手术器械冲突；在发际线内做5cm的曲线形皮肤切口，双侧使用2个骨孔进行翼点锁孔开颅；将整个手术台向一侧旋转15度，以利于显微外科经侧裂入路和动脉瘤夹闭；手术台再向另一侧旋转进行对侧手术；特别注意避免双侧脑损伤。该入路为经侧裂分离提供了最小但足够的工作空间。平均手术时间5小时17分钟，安全地完成了动脉瘤颈夹闭。所有患者均未发生并发症，获得了满意的美容效果。术后神经影像学检查显示双侧完全夹闭，颅内积气最少，脑牵拉后果最小。经翼点锁孔入路一期夹闭是治疗双侧小动脉瘤的一种安全有效的治疗选择。
