편측 관자놀이 접근법을 통한 양측 뇌동맥류 결찰

초록

목적: To evaluate the technical viability of unilateral approach to bilateral aneurym and to make its proper indications. 대상: Seventeen patients with ilateral aneurysm underwent inilateral pterional approach for one stage surgical clipping of them. Successful bbliteration rate for contralateral aneurysm was investigated radiogically and clinically. 결과: Successful obliteration of contralateral aneurysm was obtained in nine of 17 contralateral artery aneurysm (Four of eight middle cerebral artery aneurys, bifurcation artery aneurysm). Incomlete obliterations were observed in three cases (two middle cerebral artery aneurysm and one of two ICA-opthalmic artery aneurysm). Contralateral surgical cliping was not possible in five cases (two middle cerebral arery aneurysm, 2 ICA-posterior communicationg artery aneurysm and one ICA-opthalmic artery aneurysm). Two cases of hyposmia, one case of visual fiedld defect and one case of hemiparesis due to perforator injury were developed after operation. 결론: Unilateral pterional approach could be considered first for one stage obliteration for bilateral artery aneurysm in case of contralateral ICA bifurcation aneurysm, ICA superior hypophyseal artery aneurysm and MCA bufurcation aneurysm with short M1. However, ICA aneurysm with lateral direction, such as ICA-Posterior communicating artery aneurysm and ICA anterior choroidal artery aneurysmm and ICA-opthalmic artery aneurysm seem to be contraindications for contralateral pterional approach.