접형골 융기 접근법을 통한 전방순환계 뇌동맥류 수술

Abstract

Backgroud : There are variable surgical approaches for anterior circulation aneurysms and several methods have advantage and disadvantage respectively. We describe the indications, surgical technique and complications of sphenoid ridge approach for anterior circulation aneurysms. Methods : Between March 2002 and March 2005, 25 patients harboring 28 anterior circulation aneurysms were treated with sphenoid ridge approach. There were 10 men and 15 women with a mean follow-up period of 23 months. 15 patients harbored aneurysms involving the middle cerebral artery, 6 patients had anterior communicating artery aneurysms, 5 patients had posterior communicating artery aneurysms, 2 patients had paraclinoid artery aneurysms. The authors analyzed Hunt-Hess grade and Fisher grade on admission for assessment of patient preoperatively, Glasgow outcome scale (GOS) for the clinical outcomes. Results : Among the patients undergone aneurysm clipping, 8 patients had unruptured aneurysms and 17 patients had ruptured aneurysms. The Hunt-Hess grade was grade I in 2 patients, grade II in 12 patients, grade III in 1 patient and grade IV in 2 patients. The Fisher grade was grade II in 4 patients, grade III in 9 patients and grade IV in 4 patients. The locations of aneurysms were middle cerebral artery in 15 patients, anterior communicating artery in 6 patients, posterior communicating artery in 5 patients, paraclinoid internal carotid artery in 2 patients. The average sac size of aneurysms was 4.2×5.0 mm. Outcomes were good recovery in 19 patients, moderate disability in 3 patients, severe disability in 1 patients, vegetative state in 1 patient and death in 1 patient. Complications were hypertensive intracerebral hemorrhage in 2 patients, intraoperative aneurysmal rupture in 1 patient, vasospasm in 2 patients, meningitis in 1 patient, pneumonia in 1 patient. Chemical angioplasty, tripple H therapy were performed for vasospasm and good results were obtained. Patient with pneumonia was expired eventually. Conclusion : Sphenoid ridge approach was safe and less invasive method for the treatment of anterior circulation aneurysms in Hunt-Hess grade 1,2,(3) patients and unruptured aneurysms. Minimal disruption of soft tissue, minimization of bone defect, diminished operative time and blood loss, satisfactory cosmetic result could be achieved.