상상돌기 뇌동맥류의 경막 전방 침상돌기절제술의 임상고찰

• 발행기관: 대한두개저학회
• 저자명: Jang Ho Ahn Seung Young Chung Kim Han Kyu Do Sung Lee Ki Suk Park Seong Min Kim Moon Sun Park
• 간행물 정보: 『대한두개저학회지』제11권 제2호, 39~47쪽, 전체 9쪽
• 주제분류: 의약학 > 일반외과학
• 파일형태: PDF
• 발행일자: 2016.09.30

영문 초록

Objective : Paraclinoid segment internal carotid artery (ICA) aneurysms have historically been a technical challenge for neurovascular surgeons. The development of microsurgical approach, advances in surgical techniques, and endovascular procedures have improved the outcome for paraclinoid aneurysms. However, many authors have reported high complication rates from microsurgical treatments. Therefore, the present study reviews the microsurgical complications of the extradural anterior clinoidectomy for treating paraclinoid aneurysms and investigates the prevention and management of observed complications. Methods : Between January 2004 and April 2008, 24 patients with 26 paraclinoid aneurysms underwent microsurgical direct clipping by a cerebrovascular team at a regional neurosurgical center. Microsurgery was performed via an ipsilateral pterional approach with extradural anterior clinoidectomy. We retrospectively reviewed patients’ medical charts, office records, radiographic studies, and operative records. Results : In our series, the clinical outcomes after an ipsilateral pterional approach with extradural anterior clinoidectomy for paraclinoid aneurysms were excellent or good (Glasgows Outcome Scale : GOS 5 or 4) in 88.4% of cases. The microsurgical complications related directly to the extradural anterior clinoidectomy included transient cranial nerve palsy (8), cerebrospinal fluid leak (1), worsened change in vision (1), unplanned ICA occlusion (1), and epidural hematoma (1). Only one of the complications resulted in permanent morbidity (3.8%), and none resulted in death. Conclusion : Although surgical complications are still reported to occur more frequently for the treatment of paraclinoid aneurysms, the permanent morbidity and mortality resulting from a extradural anterior clinoidectomy in our series were lower than previously reported. Precise anatomical knowledge combined with several microsurgical tactics can help to achieve good outcomes with minimal complications.

목차

서론

대상 및 방법

임상 양상

수술 방법

결과

미세 수술 합병증

Discussion

결론

키워드

경막 전방 침상돌기절제술 상상돌기 뇌동맥류 임상 결과 수술적 합병증