Kashimura Hiroshi, Ogasawara Kuniaki, Kubo Yoshitaka, Ogawa Akira
Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
Neurol Med Chir (Tokyo). 2007 Jun;47(6):282-4; discussion 284. doi: 10.2176/nmc.47.282.
Neck clipping for internal carotid-posterior communicating artery (IC-PC) aneurysms using standard straight, angled, or curved clip may result in remnant aneurysm neck. We describe complete neck clipping of IC-PC aneurysms using a bayonet-shaped clip. The bayonet-shaped clip is applied perpendicular to the long axis of the internal carotid artery (ICA), and the blades of the clip are inserted between the aneurysm neck and the ICA. Using the clip applicator, the clip is gradually rotated counterclockwise or clockwise for left or right ICA aneurysm, respectively, so that the distal and shank portions of the clip blade are located at the aneurysm neck in the posterior communicating artery (Pcom) and ICA, respectively. As a result, the distal flexure of the clip blade fits the junction of the ICA and Pcom. This technique was used in four patients with ruptured ICA aneurysms and five patients with unruptured ICA aneurysms. Postoperative cerebral angiography demonstrated no residual aneurysm neck and preservation of the Pcom in all patients. This technique is useful for cases of IC-PC aneurysm involving the origin of the Pcom.
使用标准的直形、角形或弯形夹对颈内动脉-后交通动脉（IC-PC）动脉瘤进行颈部夹闭可能会导致动脉瘤颈部残留。我们描述了使用刺刀形夹对IC-PC动脉瘤进行完全颈部夹闭的方法。将刺刀形夹垂直于颈内动脉（ICA）的长轴放置，夹的叶片插入动脉瘤颈部和ICA之间。使用夹钳，对于左侧或右侧ICA动脉瘤，分别将夹逐渐逆时针或顺时针旋转，以使夹叶片的远端和柄部分别位于后交通动脉（Pcom）和ICA的动脉瘤颈部。结果，夹叶片的远端弯曲部贴合ICA和Pcom的交界处。该技术用于4例破裂的ICA动脉瘤患者和5例未破裂的ICA动脉瘤患者。术后脑血管造影显示所有患者均无残留动脉瘤颈部且Pcom得以保留。该技术对于涉及Pcom起源的IC-PC动脉瘤病例很有用。
