安全,確実な脳動脈瘤手術の手順と工夫 : 動脈瘤手術の最終段階におけるdome punctureの役割(<特集>難しい脳動脈瘤の手術の問題点と工夫)  [in Japanese] Safe and Reliable Aneurysm Surgery : Role of Dome Puncture in Neck Clipping(<Topic> Aneurysm Surgery)  [in Japanese]

Observance of basic procedures is essential for safe and reliable aneurysm surgeries. At the final steps of aneurysm surgery, dome puncture is a useful procedure for various purposes. For dissection of aneurysms, temporary clipping of the proximal segment of the parent artery is usually used to reduce the tension of the aneurysm. When the tension of the aneurysm is still high despite temporary occlusion of the parent artery, dome puncture under trapping or tentative clipping is very useful to make dissection very easy. Dome puncture after neck clipping is performed to confirm complete obliteration of the neck, to observe behind the dome, and to prevent slipping-in or slipping-out of the clip.