Basal Interhemispheric Approach for Anterior Communicating Aneurysms(<SPECIAL ISSUE>Selection of Surgical Approach and Pitfall I)

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  • 前交通動脈瘤に対するbasal interhemispheric approach(<特集>手術アプローチの選択とピットフォールI-第24回微小脳神経外科解剖セミナーより-)

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Abstract

Anterior communicating aneurysms are common compared with internal carotid artery or middle cerebral artery aneurysms and often require surgical intervention. It is not easy to dissect the interhemispheric fissure and the aneurysm because of the narrow surgical space, complicated vascular structures, and existence of important perforating arteries. The basal interhemispheric approach appears to be useful in observing all vascular structures around the Acom complex. To dissect an adherent and fragile interhemispheric fissure gently and with minimal invasion, we must first distinguish to which side of the frontal lobe a microvessel belongs at the microscopic level. It is important to retract the frontal lobe using a brain spatula and aspiration tube so that the dissection plane can be identified and pial injury avoided. It is also important when using the microscope to remember that the field of view is limited and can easily be obstructed by the incorrect use of surgical instruments. The basal interhemispheric approach requires advanced surgical techniques, which we will discuss in this article.

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