Kim Louis J, Klopfenstein Jeffrey D, Spetzler Robert F
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery. 2007 Sep;61(3 Suppl):79-80; discussion 80. doi: 10.1227/01.neu.0000289717.03050.65.
To describe an alternative method of clip reconstruction and wrapping of fusiform aneurysms that provides structural support for the reconstructed parent artery or residual aneurysm.
A 57-year-old woman with an unruptured distal middle cerebral artery fusiform aneurysm underwent surgical treatment via a pterional craniotomy.
A right-angled titanium clip was used to obliterate the aneurysm and to clip reconstruct the parent vessel, which was composed of a single inflow and outflow vessel. After the aneurysm was decompressed with a fine-gauge needle, the remnant/parent artery was wrapped with a thin layer of muslin gauze followed by circumferential application of the Gore-tex (W.L. Gore and Associates, Inc., Flagstaff, AZ) sling. Finally, a second right-angled aneurysm clip was applied to the free ends of the sling immediately adjacent to the parent vessel while the sling was cinched against the parent vessel. This maneuver allowed the Gore-tex material to buttress the reconstructed vessel circumferentially.
Clip reconstruction with a Gore-tex sling preserves the parent vessel and simultaneously buttresses the reconstructed vessel wall with radial forces provided by the Gore-tex material. This method is a novel alternative to conventional methods for the treatment of fusiform aneurysms.
描述一种用于梭形动脉瘤夹闭重建和包裹的替代方法，该方法可为重建的母动脉或残余动脉瘤提供结构支撑。
一名57岁女性，患有未破裂的大脑中动脉远端梭形动脉瘤，通过翼点入路开颅手术进行治疗。
使用直角钛夹闭塞动脉瘤并夹闭重建由单一流入和流出血管组成的母血管。用细针使动脉瘤减压后，用一层薄纱布包裹残余/母动脉，随后沿圆周方向应用戈尔特斯（W.L.戈尔联合公司，弗拉格斯塔夫，亚利桑那州）吊带。最后，在将吊带紧贴母血管收紧时，在紧邻母血管的吊带自由端应用第二个直角动脉瘤夹。这一操作使戈尔特斯材料能够沿圆周方向支撑重建的血管。
使用戈尔特斯吊带进行夹闭重建可保留母血管，同时利用戈尔特斯材料提供的径向力沿圆周方向支撑重建的血管壁。该方法是治疗梭形动脉瘤的传统方法的一种新颖替代方法。
