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APPLICATION OF MICROSURGICAL TECHNIQUE TO INTRACRANIAL VASCULAR SURGERY Hiro Chigasaki 1 1Dept. of Neurosurgery, Juntendo University pp.502-511
Published Date 1970/4/1
DOI https://doi.org/10.11477/mf.1406202717
  • Abstract
  • Look Inside

Although the operating binocular microscope has been used for fairly long time in the otolaryngology and ophthalmology, it is only for the last several years that the microsurgical technique with the operating microscope is introduced into the neurosur-gical operations. Quite different from the oto-, oph-thalmological organs, the brain and the spinal cord are highly vascularized and very difficult in controll-ing the bleeding during the operation and this fact gives much disadvantages and often makes it im-possible to continue the operation under the micro-scope. Therefore, the introduction of microvascular technique into the neurosurgical operations byDonaghy and Yasargil has brought remarkable technical progress and improvement in the micro-neurosurgery.

The operating microscope for neurosurgical opera-tions needs specially free mobility during the opera-tive procedure and good illumination in the deep field. In the microneurosurgery, delicate microsurgi-cal insruments, specially a good bipolar coagulator unit with miniatured forceps are indispensable as well as the operating microscope.

In the neurosurgical operations, intracranial vas-cular surgery is the most useful and fruitful indica-tion of application of microsurgical and microvascular technique. Although still needed for surgeon's skill-fulness and experience, dissection (sharp dissection) around the aneurysmal neck and clipping, ligation or resection of the aneurysm, preserving the sur-rounding normal brain tissue and vessels which procedure is thought to be essential for the post-operative good prognosis are much more easily done under the microscope. The deep seated intracranialarterio-venous malformation can be totally extirpated more easily and steadily without any serious post-operative neulological deficit, if the lesion is carefully and bloodlessly dissected from the adjacent normal brain tissue under the microscope.

With progress of microvascular surgery, embolect-omy, endoarterectomy and anastomosis with other vessels in the cranial main vessels (0.51 mm in diameter) can be performed with success. However, technically successful, it has still many problems to solve about the clinical significance and indication of this kind of procedures.

Although with use of the microsurgical technique neurosurgeons are able to handle intracranial vas-cular lesions more finely, easily and steadily, they should know that microsurgery is only a kind of new tool for neurosurgical operations, which still needs their full knowledge and long experience about neurosurgery.


Copyright © 1970, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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