La Pira Biagia, Sturiale Carmelo Lucio, Della Pepa Giuseppe Maria, Albanese Alessio
Department of Neurosurgery, Sapienza University of Rome, Rome, Italy.
Institute of Neurosurgery, Catholic University School of Medicine, L.go A. Gemelli 8, 00168, Rome, Italy.
Acta Neurochir (Wien). 2018 Feb;160(2):295-299. doi: 10.1007/s00701-017-3387-6. Epub 2017 Nov 11.
The far-lateral is a standardised approach to clip aneurysms of the posterior inferior cerebellar artery (PICA). Different variants can be adopted to manage aneurysms that differ in morphology, topography, ruptured status, cerebellar swelling and surgeon preference.
We distinguished five paradigmatic approaches aimed to manage aneurysms that are: proximal unruptured; proximal ruptured requiring posterior fossa decompression (PFD); proximal ruptured not requiring PFD; distal unruptured; distal ruptured.
Preoperative planning in the setting of PICA aneurysm surgery is of paramount importance to perform an effective and safe procedure, to ensure an adequate PFD and optimal proximal control before aneurysm manipulation.
远外侧入路是夹闭小脑后下动脉（PICA）动脉瘤的一种标准化方法。对于形态、位置、破裂状态、小脑肿胀情况及术者偏好不同的动脉瘤，可采用不同的变体术式。
我们区分了五种针对不同类型动脉瘤的典型手术入路，分别为：近端未破裂型；近端破裂且需要后颅窝减压（PFD）型；近端破裂但不需要PFD型；远端未破裂型；远端破裂型。
PICA动脉瘤手术的术前规划对于实施有效且安全的手术、确保在处理动脉瘤前进行充分的PFD及实现最佳近端控制至关重要。
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