Kurokawa Y, Uede T, Honda O, Kato T, Wanibuchi M, Honmou O, Hashi K
Department of Neurosurgery, Kushiro City General Hospital.
No Shinkei Geka. 1994 Jan;22(1):29-34.
The interhemispheric approach has been selected for clipping of the anterior communicating artery aneurysm located high above the sphenoidal plate, and in a posterior direction. However, this approach is sometimes complicated with postoperative hemorrhagic infarction due to excess brain retraction combined with damages of the cortical bridging veins. We have devised a modification in this approach to eliminate these complications. Our newly devised methods include the following; 1) Small bifrontal craniotomy performed, 2) Continuous ventricular drainage performed to minimize the effect of compression by the spatula during resection of interhemispheric fissure, 3) Bifrontal dural incision made along the frontal skull base, 4) Mobilization of the major cortical vein in the operated field, if necessary, by resection of the overlying arachnoid membrane with or without sacrificing its small tributaries, 5) Gradual dissection of the olfactory nerves according to the process of operation. We analysed the incidence of operative complications in thirteen consecutive cases with this approach. Major frontal ascending veins were carefully preserved in all cases. None showed hemorrhagic infarction, regardless of the cortical venous drainage patterns. The degree of smell preserved in 10% of the examined 11 cases was more than unilateral. In conclusion, this method is useful for the elimination of perioperative complications even in the acute stage of subarachnoid hemorrhage.
已选择经半球间入路夹闭位于蝶骨平台上方高处且偏后的前交通动脉瘤。然而，这种入路有时会因过度牵拉脑组织并伴有皮质桥静脉损伤而并发术后出血性梗死。我们对该入路进行了改良以消除这些并发症。我们新设计的方法如下：1）行小双额开颅术；2）进行持续脑室引流以尽量减少在切除半球间裂期间刮匙压迫的影响；3）沿额颅底做双额硬脑膜切口；4）如有必要，通过切除覆盖的蛛网膜（可牺牲或不牺牲其小分支）来游离术野中的主要皮质静脉；5）根据手术进程逐步解剖嗅神经。我们分析了连续13例采用此入路手术的并发症发生率。所有病例中均小心保留了主要的额上升静脉。无论皮质静脉引流模式如何，均未出现出血性梗死。在11例接受检查的病例中，10%的患者嗅觉保留程度超过单侧。总之，即使在蛛网膜下腔出血急性期，该方法对于消除围手术期并发症也很有用处。
