脳卒中の外科
Online ISSN : 1880-4683
Print ISSN : 0914-5508
ISSN-L : 0914-5508
特集 内頚動脈瘤クリッピング術―総 説
大型ICA paraclinoid動脈瘤のクリッピング術とピットフォール
田中 雄一郎大塩 恒太郎伊藤 英道佐瀬 泰玄池田 哲也川口 公悠樹梶 友紘久代 裕一郎
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2020 年 48 巻 1 号 p. 1-6

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For many years, neck clipping of large internal carotid artery paraclinoid aneurysms has been challenging. However, recent technical developments in coil embolization and flow diverters have been associated with great advancements. Indeed, reducing surgical complications related to neck clipping in the era of interventional radiology is essential. The basic techniques include 1) preparation of the cervical carotid artery, 2) cannulation of the carotid artery, 3) craniotomy, 4) sectioning of the falciform ligament, 5) removal of the anterior clinoid process, 6) preparation of the ophthalmic artery, 7) temporary arterial occlusion, and 8) intraoperative angiography or indocyanine green videoangiography. Key points of the surgical techniques include appropriate preparation of the parent artery and selection of the aneurysm clips. Here, some technical details, including the removal of the anterior clinoid process, the separation of the distal dural ring and the transposition of the sphenoparietal sinus, are described to both avoid surgical complications and improve the visual outcome.

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