Objective : The focus of aneurysm surgery is eliminating unnecessary operative manipulations and preparing the surgeon for any crises that might arise. With this concept in mind, we have tried resection of the gyrus rectus without routine sylvian fissure dissection in selected patients with anterior...
Objective : The focus of aneurysm surgery is eliminating unnecessary operative manipulations and preparing the surgeon for any crises that might arise. With this concept in mind, we have tried resection of the gyrus rectus without routine sylvian fissure dissection in selected patients with anterior communicating artery (ACom) aneurysms, and compared these results with those from the conventional transsylvian approach. Methods : This retrospective study included 231 surgically treated patients with ACom aneurysms from March, 1997 to May, 2005. The patients were divided into two groups : Group A (96 with sylvian fissure dissection, March, 1997-December, 2000) and Group B (135 without sylvian fissure dissection, January, 2001-May, 2005). Overall surgical outcomes were compared, and operative times have been prospectively recorded since January, 04 to evaluate how this maneuver affected the length of surgical procedures. Results : All aneurysms were satisfactorily clipped, and there was no evidence of increased number of procedure-related retraction injuries in group B. Overall outcome was good in 186 (80.5%); 76 (79.2%) in group A, and 110 (815%) in group B ($x^2$ test, p=0.79). In good clinical grade of group A, good outcome was observed in 60 patients (89.6%) and in group B, 97 patients (94.2%) (Fisher's exact test, p=0.38) (Fig. 2). Conclusion : In this study, eliminating the step of sylvian fissure dissection by gentle lateral basal-frontal retraction to the side of the sylvian fissure did not increase morbidity and mortality. However, we do not intend to modify the standard approach to the ACom aneurysm that is familiar to and has been mastered by many others. Rather, we report our experience on the basis of our anatomic understanding of the technique and its results.
Objective : The focus of aneurysm surgery is eliminating unnecessary operative manipulations and preparing the surgeon for any crises that might arise. With this concept in mind, we have tried resection of the gyrus rectus without routine sylvian fissure dissection in selected patients with anterior communicating artery (ACom) aneurysms, and compared these results with those from the conventional transsylvian approach. Methods : This retrospective study included 231 surgically treated patients with ACom aneurysms from March, 1997 to May, 2005. The patients were divided into two groups : Group A (96 with sylvian fissure dissection, March, 1997-December, 2000) and Group B (135 without sylvian fissure dissection, January, 2001-May, 2005). Overall surgical outcomes were compared, and operative times have been prospectively recorded since January, 04 to evaluate how this maneuver affected the length of surgical procedures. Results : All aneurysms were satisfactorily clipped, and there was no evidence of increased number of procedure-related retraction injuries in group B. Overall outcome was good in 186 (80.5%); 76 (79.2%) in group A, and 110 (815%) in group B ($x^2$ test, p=0.79). In good clinical grade of group A, good outcome was observed in 60 patients (89.6%) and in group B, 97 patients (94.2%) (Fisher's exact test, p=0.38) (Fig. 2). Conclusion : In this study, eliminating the step of sylvian fissure dissection by gentle lateral basal-frontal retraction to the side of the sylvian fissure did not increase morbidity and mortality. However, we do not intend to modify the standard approach to the ACom aneurysm that is familiar to and has been mastered by many others. Rather, we report our experience on the basis of our anatomic understanding of the technique and its results.
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제안 방법
Two groups were evaluated for comparability of demographic and clinical variables in사uding age, sex, Hunt-Hess grade, Fisher Grade, aneurysm size, and direction of aneurysm, at entry by a t-test, x2, and Fishers exact tests for categories. In the final analysis of the outcome at the last follow up period, the significance of observed differences in the outcome between the groups were assessed by Fishers exact test.
대상 데이터
This retrospective study included 231 patients (unruptured, 13) with ACom aneurysms out of surgically treated patients during from March, 1997 to May, 2005. The patients were divided into two groups : Group A (96 with sylvian fissure dissection, March, 1997-Decembei; 2000) and Group B (135 without sylvian fissure dissection, January, 2001-May, 2005).
데이터처리
categories. In the final analysis of the outcome at the last follow up period, the significance of observed differences in the outcome between the groups were assessed by Fishers exact test. A Rvalue 0.
참고문헌 (10)
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Aydian IH, Kadioglu HH, Tuzun Y, Kayaoglu CR, Tuzun E, Ozturk M : Postoperative anosmia after anteior communicating artery aneurysms surgery by the pterional approach. Minim Invasive Neurosurg 39 : 71-73, 1996
Figueiredo EG, Deshmukh P, Zabramski JM, Preul MC, Crawford NR, Siwanuwatn R, et al : Quantitative anatomic study of three surgical approaches to the anterior communicating artery complex. Neurosurgery 56: 397-405, 2005
Proust F, Debono B, Hannequin D, Gerardin E, Clavier E, Langlois O, er al : Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures. J Neurosurg 99 : 13-14, 2003
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