Mücke T, Scholz M, Kesting M R, Wolff K-D, Schmieder K, Harders A G
Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Munich, Germany.
Minim Invasive Neurosurg. 2008 Feb;51(1):6-10. doi: 10.1055/s-2007-1004548.
To adapt to the changed approach in the treatment of aneurysms, the authors have developed three different experimental aneurysm models for teaching clipping, microvascular Doppler sonography and shrinking.
39 microaneurysms were created in 22 animals in three different locations at the carotid, femoral and iliac arteries and treated by neurosurgical clipping. Additionally, shrinking was accomplished in selected cases. Microvascular Doppler sonography with a 20-MHz microprobe was performed prior to and after clipping to assess the achieved result of the clipping manoeuvre. Multiple clip applications in different techniques were performed for optimisation of clip placement and additional training.
All created aneurysms could be clipped successfully. The mean duration for clipping and control of clipping results by the micro-Doppler was 8:51+/-4:41 minutes at all aneurysms. The aneurysm clip was repositioned in 16 of 39 (41%) cases, on the basis of the Doppler findings in 14 aneurysms (36%). A relevant stenosis was detected in 10 (25.7%) and incomplete occlusion in 4 (10.2%) attempts. In one aneurysm vasospasm was detected at the distal part of the parent artery. Complete clipping was achieved in all cases. During the entire procedure three unexpected complications involving rupture and bleeding impeded the training.
Surgically induced aneurysms in rats allow the possibility of multiple clipping, shrinking and micro-Doppler sonography for the simulation of aneurysm treatment.
为适应动脉瘤治疗方法的变化,作者开发了三种不同的实验性动脉瘤模型,用于教学夹闭、微血管多普勒超声检查和缩小治疗。
在22只动物的颈动脉、股动脉和髂动脉的三个不同位置制造了39个微动脉瘤,并通过神经外科夹闭进行治疗。此外,在选定的病例中实现了缩小治疗。在夹闭前后使用20兆赫的微型探头进行微血管多普勒超声检查,以评估夹闭操作的效果。采用不同技术进行多次夹闭操作,以优化夹子放置并进行额外训练。
所有制造的动脉瘤均能成功夹闭。所有动脉瘤夹闭及通过微型多普勒控制夹闭结果的平均持续时间为8分51秒±4分41秒。根据14个动脉瘤(36%)的多普勒检查结果,39个病例中有16个(41%)重新放置了动脉瘤夹。在10次(25.7%)尝试中检测到相关狭窄,4次(10.2%)尝试中检测到不完全闭塞。在一个动脉瘤中,在母动脉远端检测到血管痉挛。所有病例均实现了完全夹闭。在整个过程中,三次涉及破裂和出血的意外并发症妨碍了训练。
大鼠手术诱导的动脉瘤允许进行多次夹闭、缩小治疗和微血管多普勒超声检查,以模拟动脉瘤治疗。