シルビウス裂と大脳半球間裂を無血で開けるコツは？

What Are the Useful Tips for Opening the Sylvian and Interhemispheric Fissures with Minimal Blood Loss

Point

・経シルビウス裂アプローチや経大脳半球間裂アプローチは基本的アプローチである．

・いずれのアプローチも無血で行うためにはいくつかのコツがある．

・開頭およびアプローチ，いずれにおいても適切な止血が重要である．

・アプローチ中は弱すぎず，強すぎない牽引を常に意識する．

・手術顕微鏡の拡大倍率（弱拡・強拡）を必要に応じて使い分ける．

　The transsylvian approach（TSA）and interhemispheric approach（IHA）are two basic and important surgical approaches for the treatment of cerebral aneurysms. The TSA is usually the first choice for treating middle cerebral artery aneurysms but is sometimes used for treating even anterior communicating artery, internal carotid artery, and basilar artery aneurysms. In contrast, the IHA is usually the first choice for treating anterior communicating artery and distal anterior cerebral artery aneurysms. Young inexperienced neurosurgeons may find these approaches difficult to perform without blood loss. Therefore, the aim of this study was to provide useful tips regarding hemostasis, brain retraction, and intraoperative microscope magnification for performing the TSA and IHA without blood loss by using intraoperative photography.