颅内动脉瘤手术入路解读.pptVIP

椎动脉-基底动脉区域动脉瘤 椎动脉上段动脉瘤, PICA动脉瘤; 基地动脉全长范围动脉瘤,AICA动脉瘤; 颈静脉球的影响; 乙壮窦前入路 远外侧入路 远外侧入路 小脑后下动脉瘤 远外侧入路 远外侧入路 枕下入路 枕下入路 入路原则: 1,动脉瘤原位暴露,无脑组织损伤;2,充分暴露动脉瘤,载瘤动脉和周围结构;3, * A frontotemporal flap centered at the pterion (pterional craniotomy) may be used for internal carotid artery aneurysms; The flap may be enlarged posterosuperiorly for reaching aneurysms of the middle cerebral artery and of the internal carotid artery bifurcation, forward for approaches to the anterior communicating area; posteriorly to provide a pterional-pretemporal or anterior subtemporal approach for an aneurysm of the basilar apex. * * Method of opening the scalp； Location of aneurysm: at the level of the ophthalmic or superior hypophyseal artery; In one layer, the skin and galea are elevated; In a second layer, the temporalis muscle and fascia are elevated. The two-layer scalp opening provides a lower exposure and better access for removing the anterior clinoid process and adjacent part of the orbital roof than the single-layer flap. which are commonly needed to manage aneurysms that arise proximal to the posterior communicating artery. * Method of opening the scalp Location of aneurysm: at the level of or above the posterior communicating artery, as a single layer, the skin, galea, pericranium, and temporalis muscle and fascia are reflected; * 3.4 * 3.4 * commonly selected with slight modifications: for approaching all of these aneurysms arising from the anterior circle of Willis; for some originating from the upper basilar artery; * ３。８ * Modified frontotemporal approach ３。１６ * Commonly approached by the pterional route; Less frequently by a subfrontal, bifrontal, or anterior interhemispheric approach. Left or right? Some surgeons approach all anterior communicating aneurysms from the right side. But left side should be considered: if a left frontal hematoma is present, if the fundus of the aneurysm projects toward the right, if the left anterior cerebral artery is