Suzuki M, Ogawa A
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Surg Neurol. 1999 Aug;52(2):150-1; discussion 151-2. doi: 10.1016/s0090-3019(99)00056-7.
Complete clipping of internal carotid artery (ICA) aneurysms without residual aneurysmal neck may conflict with preservation of the anterior choroidal artery, posterior communicating artery, or their branches. In addition, the neck of the aneurysm is often situated behind the ICA, as seen through the operative microscope. The blades of fenestrated clips can be inserted over the ICA, followed by reconstruction of the ICA wall to minimize the residual aneurysmal neck. However, the blades are out of the field of vision behind the ICA when they are closed, so that ICA branches or perforators may be clipped together with the aneurysmal neck. We have developed a semicircular clip to avoid this type of misclipping.
We have treated four patients with ruptured ICA aneurysms and two patients with unruptured ICA aneurysms with this semicircular clip. In all cases, the aneurysms were clipped without residual neck, and the ICA branches were preserved.
This instrumentation is especially useful in cases of ICA aneurysms protruding posteriorly or medially.
完全夹闭颈内动脉（ICA）动脉瘤且无残留瘤颈可能与保留脉络膜前动脉、后交通动脉或其分支相冲突。此外，通过手术显微镜观察，动脉瘤的瘤颈常位于颈内动脉后方。带窗夹的叶片可插入颈内动脉上方，随后重建颈内动脉壁以尽量减少残留瘤颈。然而，当叶片闭合时，它们位于颈内动脉后方的视野之外，因此颈内动脉分支或穿支可能与瘤颈一起被夹闭。我们开发了一种半圆形夹以避免此类误夹。
我们用这种半圆形夹治疗了4例破裂的颈内动脉动脉瘤患者和2例未破裂的颈内动脉动脉瘤患者。在所有病例中，动脉瘤均被夹闭且无残留瘤颈，颈内动脉分支得以保留。
这种器械在颈内动脉动脉瘤向后或向内突出的病例中特别有用。
