Pterional approachにおける静脈処理の問題点 Fronto-temporal bridging veinの考察

脳動脈瘤に対するpterional approachにおいて, シルビウス裂を可及的に開き, less retractionにて良い術野を得ることは脳動脈瘤手術の基本と思われるが, このためにはある程度の静脈処理が必要なことが多い. 一般的にsuperficial sylvian vein(SSV)はsupratemporal gyrusのanterior marginを下降し, いわゆる“temporal tip”部のbridging veinとしてsphenoparietal sinus(SPS)に流入する. この際frontal lobe底面からSSVに合流するbridging vein...

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Published in脳卒中の外科 Vol. 26; no. 4; pp. 237 - 241
Main Authors 原岡, 襄, 稲葉, 泉, 西岡, 宏, 山田, 裕二, 伊東, 洋, 斉藤, 文男
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本脳卒中の外科学会 1998
日本脳卒中の外科学会
Online AccessGet full text
ISSN0914-5508
1880-4683
DOI10.2335/scs1987.26.4_237

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Abstract 脳動脈瘤に対するpterional approachにおいて, シルビウス裂を可及的に開き, less retractionにて良い術野を得ることは脳動脈瘤手術の基本と思われるが, このためにはある程度の静脈処理が必要なことが多い. 一般的にsuperficial sylvian vein(SSV)はsupratemporal gyrusのanterior marginを下降し, いわゆる“temporal tip”部のbridging veinとしてsphenoparietal sinus(SPS)に流入する. この際frontal lobe底面からSSVに合流するbridging vein(fronto-temporal bridging vein=FTBV)はやむを得ない場合は切断可能とされ, 実際にこのためのcomplicationはまれであると考えられる. しかしながら今回われわれは, この静脈を切断したために生じたと思われる術後変化を経験したので解剖学的側面, 対処法を含め報告する.
AbstractList 脳動脈瘤に対するpterional approachにおいて, シルビウス裂を可及的に開き, less retractionにて良い術野を得ることは脳動脈瘤手術の基本と思われるが, このためにはある程度の静脈処理が必要なことが多い. 一般的にsuperficial sylvian vein(SSV)はsupratemporal gyrusのanterior marginを下降し, いわゆる“temporal tip”部のbridging veinとしてsphenoparietal sinus(SPS)に流入する. この際frontal lobe底面からSSVに合流するbridging vein(fronto-temporal bridging vein=FTBV)はやむを得ない場合は切断可能とされ, 実際にこのためのcomplicationはまれであると考えられる. しかしながら今回われわれは, この静脈を切断したために生じたと思われる術後変化を経験したので解剖学的側面, 対処法を含め報告する.
Author 稲葉, 泉
伊東, 洋
原岡, 襄
斉藤, 文男
山田, 裕二
西岡, 宏
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References 1) Batjer HH, Samson DS : Basilar apex aneurysms. In : Apuzzo MLJ (ed), Brain Surgery, Complication Avoidance and Management, New York, Churchill Livingstone, 1993, pp1048-1082
3) 原岡襄, 伊東洋, 斉藤文男, ほか : 脳動脈瘤手術への頭蓋底手術の応用. 脳卒中の外科23 : 375-381, 1995
9) Sekhar LN, Kalia KK, Yonas H : Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery 35 : 472-483, 1994
7) Kageyama Y, Fukuda K, Kobayashi S, et al : Cerebral vein disorder and postoperative brain damage associated with the pterional approach in aneurysm surgery. Neurol Med Chir (Tokyo) 32 : 733-738, 1992
10) Yasargil MG : General operative techniques. In : Yasargil MG (ed), Microneurosurgery, vol 1, Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain, Diagnostic Studies, General Operative Techniques and Pathological Considerations of the Intracranial Aneurysms, Stuttgart, Georg Thieme Verlag, 1984, pp 208-271
5) Houkin K, Takikawa S, Sawamura Y, et al : Intracranial vein reconstruction. In : Hakuba A (ed), Surgery of the Intracranial Venous System, Springer-Verlag, Tokyo, 1996, pp 375-379
11) Yasargil MG : Complications of aneurysm surgery. In : Yasargil MG (ed), Microneurosurgery, vol 2, Clinical Considerations, Surgery of the Intracranial Aneurysms and Results, Stuttgart, Georg Thieme Verlag, 1984, pp 331-339
2) Day JD, Giannotta SL, Fukushima T : Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 81 : 230-235, 1994
6) Huang YP, Wolf BS : The basal vein and its tributaries. In : Newton TH, Potts DG (eds), Radiology of the Skull and Brain : Angiography, Vol 2, Book 3, Mosby, Saint Louis, 1974, pp 2111-2154
4) Heros RC : Brain resection for exposure of deep extracerebral and paraventricular lesions. Surg Neurol 34 : 188-195, 1990
8) Seeger W : Draining veins on the cranial base and superficial veins of the cortex. In : Seeger W (ed), Microsurgery of Cerebral Veins, Springer-Verlag, Wien, 1984, pp362-405
12) Yokoh A, Sugita K, Kobayashi S : Intermittent versus continuous brain retraction. J Neurosurg 58 : 918-923, 1983
References_xml – reference: 8) Seeger W : Draining veins on the cranial base and superficial veins of the cortex. In : Seeger W (ed), Microsurgery of Cerebral Veins, Springer-Verlag, Wien, 1984, pp362-405
– reference: 12) Yokoh A, Sugita K, Kobayashi S : Intermittent versus continuous brain retraction. J Neurosurg 58 : 918-923, 1983
– reference: 1) Batjer HH, Samson DS : Basilar apex aneurysms. In : Apuzzo MLJ (ed), Brain Surgery, Complication Avoidance and Management, New York, Churchill Livingstone, 1993, pp1048-1082
– reference: 11) Yasargil MG : Complications of aneurysm surgery. In : Yasargil MG (ed), Microneurosurgery, vol 2, Clinical Considerations, Surgery of the Intracranial Aneurysms and Results, Stuttgart, Georg Thieme Verlag, 1984, pp 331-339
– reference: 3) 原岡襄, 伊東洋, 斉藤文男, ほか : 脳動脈瘤手術への頭蓋底手術の応用. 脳卒中の外科23 : 375-381, 1995
– reference: 9) Sekhar LN, Kalia KK, Yonas H : Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery 35 : 472-483, 1994
– reference: 6) Huang YP, Wolf BS : The basal vein and its tributaries. In : Newton TH, Potts DG (eds), Radiology of the Skull and Brain : Angiography, Vol 2, Book 3, Mosby, Saint Louis, 1974, pp 2111-2154
– reference: 7) Kageyama Y, Fukuda K, Kobayashi S, et al : Cerebral vein disorder and postoperative brain damage associated with the pterional approach in aneurysm surgery. Neurol Med Chir (Tokyo) 32 : 733-738, 1992
– reference: 10) Yasargil MG : General operative techniques. In : Yasargil MG (ed), Microneurosurgery, vol 1, Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain, Diagnostic Studies, General Operative Techniques and Pathological Considerations of the Intracranial Aneurysms, Stuttgart, Georg Thieme Verlag, 1984, pp 208-271
– reference: 2) Day JD, Giannotta SL, Fukushima T : Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 81 : 230-235, 1994
– reference: 5) Houkin K, Takikawa S, Sawamura Y, et al : Intracranial vein reconstruction. In : Hakuba A (ed), Surgery of the Intracranial Venous System, Springer-Verlag, Tokyo, 1996, pp 375-379
– reference: 4) Heros RC : Brain resection for exposure of deep extracerebral and paraventricular lesions. Surg Neurol 34 : 188-195, 1990
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Snippet 脳動脈瘤に対するpterional approachにおいて, シルビウス裂を可及的に開き, less retractionにて良い術野を得ることは脳動脈瘤手術の基本と思われるが, このためにはある程度の静脈処理が必要なことが多い. 一般的にsuperficial sylvian...
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StartPage 237
Subtitle Fronto-temporal bridging veinの考察
Title Pterional approachにおける静脈処理の問題点
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