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【NEW 10分で速習!スライドでわかる脳神経外科手術のポイント脳動脈瘤編】 VA-PICA ANに対する手術のコツとピットフォール
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JPY
Abstract
Clipping is still one of the treatment choices for VA-PICA ANs in this endovascular era, when the endovascular treatment is unsuitable. Transcondylar fossa approach with lateral suboccipital craniotomy is usually used for clipping of VA-PICA ANs. It is necessary to remove additionally occipital condyle or jugular tubercle when the ANs are close to the midline or in the high position1). Occlusion of the contralateral VA or trapping of the ipsilateral VA should be considered when intraoperative rupture occurs. Lower cranial nerves are obstacles when approaching to the ANs. Care should be taken not to injure these lower cranial nerves during the clip application. Clip should be applied parallelly to the PICA not to cause stenosis. Bypass surgery should be prepared when the ANs are large, thrombosed or recurred ANs after embolization. Occipital artery, which is one of the donor arteries, can be dissected before craniotomy. Caudal loop of the PICA is usually candidate for the site of anastomosis2), the variation of which should be checked in the preoperative angiography.
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