중대뇌동맥 이분지의 동맥류의 방향과 수술접근법

Abstract

Objective：This study will discuss both analysis and surgical approach for the management of middle cerebral artery bifurcation aneurysms on the basis of the author’s experience. Methods：We reviewed 105 middle cerebral artery bifurcation aneurysms in 94 patients operated from May 1997 to May 2004. The clinical presentations, neurological findings, CT findings, operative approaches and outcome were analyzed. The standard pterional approach was used. The sylvian fissure can be opened in one of three ways; the medial sylvian fissure approach, distal sylvian fissure approach, transcortical approach. We favor a lateral to medial sylvian approach for most aneurysms, because it provides excellent exposure of the aneurysm and minimizes manipulation of the brain and vascular structures. Results：The mean age was 55 years. 72 patients (76.6%) had subarachnoid hemorrhage (SAH), 22 patients (23.4%) had both SAH and intracranial hemorrhage (ICH). Of the 94 patients, 68 patients had single aneurysm and 26 patients had multiple aneurysm. Distal sylvian fissure approach was used in 69 operations and proximal sylvian fissure approach was used in 29 operations. The transcortical approach was used in 9 operations. 85 patients among 94 patients had good outcome after surgery. 2 patients remained disabled, and 4 patients died. Conclusion：We suggest that distal sylvian fissure approach can be used as routine method of operation for the management of middle cerebral artery aneurysms unless patients have either multiple aneurysms or ICH.