Eguchi T, Fuchinoue T, Yahagi Y
No Shinkei Geka. 1979 May;7(5):513-7.
A lower basilar trunk aneurysm is rare and it has been difficult to operate on this kind of aneurysm which is located in so-called "no man's land". We have recently operated on the aneurysm which was located between the vertebrobasilar junction and the origin of AICA. The aneurysm was approached posterior-subtemporal-transtentorially and wrapped with a muscle piece because of its broad neck. After the operation the patient developed amnestic aphasia which, however, disappeared 4 months postoperatively. The advantage of this approach is that it enables a better visualization of the lower basilar trunk, the lateroventral portion of the pons, the distal part (5 mm) of both vertebral arteries and the upper portion of the medulla oblongata than any other approaches hitherto reported. The retraction of the temporal lobe and subsequent brain damage may be minimized by using intraoperative ventricular drainage and microtechnical maneuver.
基底动脉下段动脉瘤较为罕见，对位于所谓“无人区”的此类动脉瘤进行手术一直颇具难度。我们最近对位于椎基底动脉交界处与小脑前下动脉起始部之间的动脉瘤实施了手术。该动脉瘤经颞下后入路经小脑幕切开，因其瘤颈较宽，遂用一块肌肉片进行包裹。术后患者出现遗忘性失语，但在术后4个月消失。此入路的优点在于，与迄今报道的任何其他入路相比，它能更好地显露基底动脉下段、脑桥的外侧腹侧部分、双侧椎动脉的远端部分（5毫米）以及延髓的上部。通过术中脑室引流和显微技术操作，可将颞叶牵拉及随后的脑损伤降至最低限度。
