1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and.
2Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan.
J Neurosurg. 2020 Mar 20;134(3):999-1005. doi: 10.3171/2020.1.JNS192823. Print 2021 Mar 1.
The sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)-posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique.
The authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed.
With the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed.
The SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.
蝶骨翼内的脑与硬脑膜之间的大脑镰桥静脉可以限制大脑回缩，从而扩大外侧颈内动脉（ICA）-后交通动脉（PCoA）和基底尖（BX）动脉瘤夹闭手术中的侧颈动脉后空间。在这种情况下，作者采用硬膜外前床突切除术，将颞骨骨膜从硬脑膜和眶上裂周围的海绵窦内膜上剥离，切口从颞侧底部延伸至ICA 远侧硬膜环（作者称之为蝶顶窦移位[SPST]技术）。该技术将大脑镰桥静脉的桥接段向后移位，在不损伤静脉的情况下扩大手术空间。在这项研究中，作者观察了手术细节，并研究了该技术的实用性。
作者回顾性分析了 2016 年 1 月至 2018 年 7 月期间 66 例 ICA-PCoA 和 BX 动脉瘤患者的病历。该技术应用于 8 例患者（5 例 PCoA 动脉瘤和 3 例 BX 动脉瘤），这些患者的大脑与颅底之间的大脑镰桥静脉段限制了大脑回缩以扩大手术空间。在使用 SPST 技术前后，在最易观察的工作角度测量外侧颈内动脉后空间和动脉瘤的表面积。
使用 SPST 技术，所有患者均保留桥静脉，获得了足够的动脉瘤夹闭手术空间。外侧颈内动脉后空间（p = 0.002）和动脉瘤（p = 0.001）的表面积分别从使用 SPST 技术前的 18.3 ± 18.8 和 2.8 ± 2.5 cm2显著增加到使用后的 64.2 ± 21.1 和 20.9 ± 20.6 cm2。
SPST 技术可在不损伤静脉的情况下使大脑镰桥静脉的桥接段移位，并可扩大外侧颈内动脉后区域的手术空间。
