半球間裂アプローチによるクリッピング

Interhemispheric Approach for Ruptured Anterior Communicating Artery Aneurysms

Point

・破裂前交通動脈瘤に対する経大脳半球間裂アプローチは，あらゆる状況に対応可能で，最も安全かつ確実な手術アプローチである．

・破裂脳動脈瘤に対する手術では再破裂予防が最も優先されるが，嗅神経損傷や髄液漏予防も確実に行う必要がある．

・破裂瘤ではA1の確保が優先されるため，動脈瘤に近づいてからの手順については工夫が必要である．

　The interhemispheric approach is very useful for the safe and reliable clipping of ruptured anterior communicating aneurysms. This approach enables surgeons to directly visualize the aneurysm and the surrounding vessels, including perforators, and provides a wide surgical corridor for clip insertion from multiple directions. Furthermore, in challenging situations, this approach facilitates vascular reconstruction without the need for graft harvesting. However, because of the procedural difficulty, many young and inexperienced neurosurgeons may hesitate to perform this technique. Therefore, this study aimed to provide useful tips, based on intraoperative photography, for skin and dural incisions, prevention of cerebrospinal fluid leakage and olfactory impairment, and fundamental steps for opening tight interhemispheric fissures. Finally, representative challenging cases that were adequately managed using the advantages of this approach are presented.