神外世界朗读者阿哈提朗读丨第37期

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中国人民解放军第三〇九医院神经外科

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阿哈提（Unique）朗读(第二部分)动脉瘤手术基本功--必要的脑切除---SevenAneurysms系列第八期

■DomeAvoidance--避开动脉瘤顶

Braintransgressionremovessurgicalobstaclessuchasthegyrusrectus,butisequallyimportantinavoidingdangerousdissectionadjacenttoaneurysmdomes.Withmiddlecerebralartery(MCA)aneurysms,thedomemayadheretothesuperiortemporalgyrusortheposteriorparsorbitalisinthefrontallobe,therebyblockingaccesstotheunderlyinginferiorandsuperiortrunks,respectively.Withophthalmicarteryaneurysms,thedomemayadheretothemedialor-bitalgyrusandlimitfrontalloberetractionneededforananteriorclinoidectomy.Withpericallosalarteryaneurysms,thedomemayadheretothecingulategyrusandinterferewiththedissectionofafferentarteries.Bydeliberatelyleavingthesubarachnoidspace,thesometimestightplanebetweenathinaneurysmandtheadherentpiaisavoided.Afterreestablishingthesubarachnoidplanebeyondthepointofadhesion,athinpatchofbrainandpiaremainsattachedtotheaneurysmdome.Theaneurysmbe