내경-후교통 동맥류 수술시 전 상상돌기 절제 유무에 대한 술전 혈관조영술의 의의

Preoperative Angiographic Value in Anterior Clinoidectomy for Surgery of Internal Carotid-Posterior Communicating Artery(IC-PC) Aneurysms

  • 김재훈 (한양대학교 의과대학 구리병원 신경외과학교실) ;
  • 김재민 (한양대학교 의과대학 구리병원 신경외과학교실) ;
  • 이형중 (한양대학교 의과대학 구리병원 신경외과학교실) ;
  • 백광흠 (한양대학교 의과대학 구리병원 신경외과학교실) ;
  • 김충현 (한양대학교 의과대학 구리병원 신경외과학교실) ;
  • 오석전 (한양대학교 의과대학 구리병원 신경외과학교실)
  • Kim, Jae Hoon (Department of Neurosurgery, Hanyang University Kuri Hospital) ;
  • Kim, Jae Min (Department of Neurosurgery, Hanyang University Kuri Hospital) ;
  • Yi, Hyeong Joong (Department of Neurosurgery, Hanyang University Kuri Hospital) ;
  • Bak, Koang Hum (Department of Neurosurgery, Hanyang University Kuri Hospital) ;
  • Kim, Choong Hyun (Department of Neurosurgery, Hanyang University Kuri Hospital) ;
  • Oh, Suck Jun (Department of Neurosurgery, Hanyang University Kuri Hospital)
  • 투고 : 1999.12.21
  • 심사 : 2000.03.17
  • 발행 : 2000.09.28

초록

Objective : Internal carotid-posterior communicating artery(IC-PC) aneurysms can be clipped easily without any special preparations. Occasionally, however, it is difficult to clip the low-lying IC-PC aneurysms without some kinds of additional procedures. Clinical Material and Methods : We experienced four cases of low-lying IC-PC aneurysms, which the intradural anterior clinoidectomy and/or anterior petroclinoid fold(APF) resection was essential to expose the proximal side of the aneurysmal neck and/or proximal control. One patient harbored two low-lying IC-PC aneurysms bilaterally. The patients were divided into two groups according to the necessity of anterior clinoidectomy : Group I(n=4) that needed an intradural clinoidectomy and/or APF resection and Group II(n=29) that had IC-PC aneurysms, easily clipped without any special preparation. Also, various radiometric parameters were measured through the preoperative angiograms. Results : The incidence of such aneurysms was 12% among a total of thirty-three surgically treated IC-PC aneurysms during lasr 3 years. Among four cases, three cases presented with subarachnoid hemorrhage and all aneurysmal sac projected to postero-inferior direction. In our study, We initially considered the necessity of intraoperative anterior clinoid process(ACP) removal and/or resection of APF in cases of shorter distance less than 5.6mm between the proximal aneurysmal sac and tip of the ACP(p<0.001), and the proximal portion of aneurysmal neck has located below the interclinoid line(p=0.001). Conclusion : Through a careful preoperative evaluation, some radiometric parameters can be used to determine whether the ACP should be removed in clipping of the low-lying IC-PC aneurysms. Unlike to total removal of the ACP, the intradural partial anterior clinolidectomy and/or APF resection, which are more familiar to surgeons, reduce the risks of the premature rupture, operative time, and also contribute a more precise clip placement with proximal control than the extradural clinoidectomy.

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