추골동맥 몸통부 및 후·하소뇌동맥 근위부 동맥류에 대한 원위측후두하접근법을 통한 수술 결과

Surgical Results of Far Lateral Suboccipital Approach for the Vertebral Artery Trunk and Proximal Posteroinferior Cerebellar Artery Aneurysms

Vertebral artery (VA) trunk and proximal posteroinferior cerebellar artery (PICA) aneurysms are challenging problem to treat surgically, with high reported perioperative complication rates. We describe the postoperative complications and clinical outcomes obtained via a far lateral suboccipital approach in 3 ruptured VA trunk and 6 ruptured proximal PICA aneurysms. Datas were collected retrospectively about the 3 VA trunk and 6 proximal PICA aneurysms treated surgically by a single surgeon between January 2001 and December 2004. Direct aneurysm clippings were achieved in 7 cases. In 2 cases, trappings without a revascularization procedure were used for dissecting VA aneurysms. Three patients(33.3%) who had the postoperative mild to moderate low cranial nerve palsy (LCNP) completely recovered within 3 months. Although the surgical clipping of VA trunk and proximal PICA aneurysms is very difficult, a far lateral suboccipital approach can provide the adequate space to clip without undue manupulation of the low cranial nerves and with minimal cerebellar retraction. The authors recommend that surgical obliteration of the aneurysm via the far lateral suboccipital approach be considered a first-line therapeutic option for the favorable outcomes and low postoperative morbidity in this subset of patients.