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Koizumi Hiroyuki,Yamamoto Daisuke,Handa Hajime,Saruta Wakiko,Shimizu Satoru,Hide Takuichiro,Kumabe Toshihiro 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.3
Metal fixation systems for cranial bone flaps cut by a drill are convenient devices for cranioplasty, but cause several complications. We use modified craniotomy using a fine diamond-coated threadwire saw (diamond T-saw) to reduce the bone defect, and osteoplasty calcium phosphate cement without metal fixation. We report our outcomes and tips of this method. A total of 78 consecutive patients underwent elective frontotemporal craniotomy for clipping of unruptured intracranial aneurysms between 2015 and 2019. The follow-up periods ranged from 13 to 66 months. The bone fixation state was evaluated by bone computed tomography (CT) and three-dimensional CT (3D-CT). The diamond T-saw could minimize the bone defect. Only one wound infection occurred within 1 week postoperatively, and no late infection. No pain, palpable/cosmetically noticeable displacement of the bone flap, fluid accumulations, or other complications were observed. The condition of bone fixation and the cosmetic efficacy were thoroughly satisfactory for all patients, and bone CT and 3D-CT demonstrated that good bone fusion. No complication typical of metal fixation occurred. Our method is technically easy and safety, and achieved good mid-term bone flap fixation in the mid-term course, so has potential for bone fixation without the use of metal plates.
뇌저동맥류에의 Approach : Optic Carotid Triangle로부터의 Approach Pterional Approach Via Optic-Carotid Triangle
정광진,Nagasawa, Shiro,Yonekawa, Yasuhiro,Handa, Hajime 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.3
There have been known two routes in pterional approach to the distal basilar artery aneurysms: one is via the space between the optic nerve and internal carotid artery (optic-carotid triangle: OCT) and the other is lateral to the ICA (retrocarotid approach: RCA). Although the approach via OCT has several advantages of its own, it had been considered to be used in a very limitted cases. Since we successfully clipped the aneurysms via OCT in 4 cases out of 12 (33%), neuroradiological findings observed in these 4 cases are analyzed and reported. Measurements were made in the following items on the carotid angiogram of the cases operated via OCT (OCT group) and RCA (RCA group) : the distance of ICA bifurcation from midline (D), height of ICA bifurcation from the base line between anterior and posterior clinoid process (H). Although these two values seemed to be higher in OCT group than those in RCA group, no significant difference was found. The product of D and H(D×H) was observed to be significantly higher in OCT group than in RCA group. The value of D×H is considered one of the indicators of the size of OCT and is proved to be useful to judge whether approach via OCT is applicable or not. The approach via OCT has several such advantages as no injury to the occulomotor nerve, less retraction to ICA and easy visualization of p1 segment of the opposite side. The space of OCT can be used not only for clipping itself but also as a line of sight to the deep structures as well as clip applied from other routes.