混合手术室平行夹闭技术治疗复杂大脑中动脉瘤的临床疗效

Q4 Medicine

中华神经外科杂志 Pub Date : 2020-01-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2020.01.013

Gang Wang, Yunyu Wen, Y. Liao, Guo-zhong Zhang, Ming-zhou Li, Siyuan Chen, S. Qi, Wenfeng Feng

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There were 19 aneurysms in 13 patients, of which 5 were single MCA aneurysms, 1 was bilateral MCA aneurysms, and the remaining 7 patients were single MCA aneurysms. The aneurysm embolization was evaluated by Raymond classification, and the clinical outcome was evaluated by modified Rankin Scale (mRS) criteria. \n \n \nResults \nThirteen patients with 19 aneurysms underwent successful clipping. A total of 60 aneurysm clips were used. For each aneurysm, we used 1 to 6 (3.2 ± 1.6) clips. After aneurysm clipping, intraoperative angiographic review revealed clipping insufficiency (Raymond grade II) in 4 aneurysms, and 2 patients with parent aneurysm stenosis. After adjustment of the aneurysm clip, all aneurysms were completely occluded (Raymond grade Ⅰ) and the parent aneurysm had no stenosis. Only one patient developed postoperative cerebral infarction in the basal ganglia and slight hemiplegia resulting from occlusion of a branch emanating from the aneurysm wall. 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引用次数: 0

摘要

目的探讨复合手术室平行夹持技术治疗复杂脑中动脉瘤的效果。方法回顾性分析南方医科大学南方医院神经外科2015年1月至2019年2月收治的13例MCA合并动脉瘤患者的临床资料。所有患者均在混合手术室行单侧经颅入路开颅手术。术中使用多个动脉瘤夹夹住动脉瘤。13例患者中7例动脉瘤破裂，4例为Hunt-Hess级Ⅰ，1例为Ⅲ，2例为Ⅳ;6例为未破裂动脉瘤。13例患者共19个动脉瘤，其中5例为单MCA动脉瘤，1例为双侧MCA动脉瘤，其余7例为单MCA动脉瘤。采用Raymond分级法评价动脉瘤栓塞，采用改良Rankin评分(mRS)标准评价临床疗效。结果13例19个动脉瘤均成功夹闭。总共使用了60个动脉瘤夹。对于每个动脉瘤，我们使用1 ~ 6个(3.2±1.6)夹子。动脉瘤夹闭后，术中血管造影复查显示4例动脉瘤夹闭不全(Raymond II级)，2例动脉瘤狭窄。调整动脉瘤夹后，所有动脉瘤均被完全闭塞(Raymond级Ⅰ)，母动脉瘤无狭窄。只有一名患者发生了基底节区脑梗死和轻微偏瘫，这是由于动脉瘤壁发出的分支闭塞造成的。出院时，10例患者的mRS为0,2例患者为2,1例患者为5。13例患者随访6 ~ 36个月(中位:17.3个月)。10例mRS为0,2例为1,1例为4。复查6例，无一例动脉瘤复发。结论复合手术室内应用多动脉瘤夹成形夹持MCA复合动脉瘤效果好，并发症少。关键词:颅内动脉瘤;大脑中动脉;显微外科;平行裁剪技术;杂交手术

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Clinical efficacy of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms

Objective To explore the outcome of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms. Methods A retrospective analysis was conducted on the clinical data of 13 patients with MCA complicated aneurysm admitted to Department of Neurosurgery, Nanfang Hospital of Southern Medical University from January 2015 to February 2019. All patients underwent a unilateral craniotomy with transpterional approach in the hybrid operating room. Multiple aneurysm clips were used to clip the aneurysm during the operation. Of the 13 patients, 7 were ruptured aneurysms, 4 were Hunt-Hess grade Ⅰ, 1 were Ⅲ, and 2 were Ⅳ; 6 were unruptured aneurysms. There were 19 aneurysms in 13 patients, of which 5 were single MCA aneurysms, 1 was bilateral MCA aneurysms, and the remaining 7 patients were single MCA aneurysms. The aneurysm embolization was evaluated by Raymond classification, and the clinical outcome was evaluated by modified Rankin Scale (mRS) criteria. Results Thirteen patients with 19 aneurysms underwent successful clipping. A total of 60 aneurysm clips were used. For each aneurysm, we used 1 to 6 (3.2 ± 1.6) clips. After aneurysm clipping, intraoperative angiographic review revealed clipping insufficiency (Raymond grade II) in 4 aneurysms, and 2 patients with parent aneurysm stenosis. After adjustment of the aneurysm clip, all aneurysms were completely occluded (Raymond grade Ⅰ) and the parent aneurysm had no stenosis. Only one patient developed postoperative cerebral infarction in the basal ganglia and slight hemiplegia resulting from occlusion of a branch emanating from the aneurysm wall. At discharge, the mRS was 0 in 10 patients, 2 in 2 patients, and 5 in 1 patient. Thirteen patients were followed up for 6 to 36 months (median: 17.3 months). The mRS was 0 in 10 cases, 1 in 2 cases, and 4 in 1 case. In 6 cases of re-examination, none of the aneurysms recurred. Conclusion The use of multiple aneurysm clips in the hybrid operating room to shape and clamp MCA complex aneurysms is effective and has few complications. Key words: Intracranial aneurysm; Middle cerebral artery; Microsurgery; Parallel clipping technique; Hybrid surgery

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.