Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA
Neurosurgery. 2009 Dec;65(6):E1210-1; discussion E1211. doi: 10.1227/01.NEU.0000357324.86905.DC.
Surgical clipping and parent vessel reconstruction of wide-neck paraclinoid aneurysms can be very challenging. We report a case of a ruptured paraclinoid aneurysm which failed standard clipping techniques. We were able to reconstruct this aneurysm while providing proximal and distal control using an adjuvant endovascular balloon.
We report the case of a 45-year-old woman presenting with a ruptured large paraclinoidal aneurysm, which involved a significant portion of the internal carotid artery wall.
Repeated attempts at fenestrated clip placement resulted in slipping of the clip and occlusion of the parent artery. Ultimately, the aneurysm ruptured at the neck, and, despite trapping and direct aneurysmal suction decompression, significant bleeding was encountered. The bleeding point was packed, and, subsequently, endovascular access was obtained. A balloon was navigated and then inflated across the neck of the aneurysm using C-arm fluoroscopic guidance. The aneurysm was successfully clipped, and intraoperative angiography demonstrated no parent vessel stenosis.
This case demonstrates a salvage procedure in the event of intraoperative rupture and inadequate interruption of local blood flow. Balloon inflation resulted in adequate hemostasis and provided intraluminal support for optimal clip placement while preserving the parent artery.
外科夹闭和载瘤动脉重建宽颈眼动脉瘤极具挑战性。我们报告一例破裂的眼动脉瘤，标准夹闭技术失败。我们使用辅助性的血管内球囊成功地重建了这个动脉瘤，同时提供了近端和远端的控制。
我们报告了一例 45 岁女性，表现为破裂的大型眼动脉瘤，累及颈内动脉壁的很大一部分。
多次尝试开窗夹放置导致夹闭器滑脱和载瘤动脉闭塞。最终，动脉瘤在颈部破裂，尽管进行了夹闭和直接抽吸减压，但仍遇到大量出血。出血部位被填塞，随后获得了血管内入路。球囊在 C 臂荧光透视引导下穿过动脉瘤颈部进行导航和充气。动脉瘤被成功夹闭，术中血管造影显示载瘤动脉无狭窄。
如果术中发生破裂和局部血流中断不足，本病例演示了一种挽救性手术。球囊充气导致充分止血，并提供了管腔内支撑，以实现最佳夹闭，同时保留载瘤动脉。
