経シルビウス裂アプローチによるクリッピング—基本から応用まで

Clipping via the Transsylvian Approach:From Basic to Advanced Surgical Techniques

Point

・経シルビウス裂アプローチで大切なことは，確実な視認，解剖学的認識と，安定した操作である．

・実際の手技は，動静脈の所属を把握する，脳を優しく動かして空間を作る，切るべきくも膜を切る，動脈を追う，という作業になる．

・くも膜下出血の手術は洗う手術である．正常構造物が見えるまで洗浄・吸引を繰り返し，切るべきものが見えてから切り，動脈を頼りに進む．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2027年10月まで）。

　The transsylvian approach is one of the most commonly used approaches in neurosurgery and is essential for clipping aneurysms located in the anterior cranial circulation, such as the middle cerebral artery, internal carotid artery, and anterior communicating artery. Moreover, basilar artery aneurysms can be clipped using this approach, albeit with some modifications.

　Important tips for dissecting the Sylvian fissures include reliable visualization, anatomical recognition, and steady manipulation. The actual steps are as follows: determine the affiliation of the arteries and veins, gently move the brain to create a wide space, cut the arachnoid mater, and follow the course of the arteries. In case of subarachnoid hemorrhage, irrigation and flushing out the hematoma is the key step involved in recognizing the structure and safely performing surgery.

　Here, we describe the basic key operative techniques for performing clipping via the transsylvian approach.