Sano Hirotoshi
Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan.
Acta Neurochir Suppl. 2010;107:27-31. doi: 10.1007/978-3-211-99373-6_4.
To evaluate the efficacy of multiple clip application for the occlusion of complex intracranial aneurysms, analyzing the technique and outcome of big and giant cerebral aneurysms clipped in our institution.
A total of 259 giant and large intracranial aneurysms (65 ruptured and 193 unruptured) were treated at Fujita Health University Hospital by clipping from January 1975 till December 2008. All patients were treated by multiple clipping according to our multiple clipping technique with reconstruction of the parent vessel. All patients underwent preoperative 3D computed tomography and some patients in addition received digital subtraction angiography. We examined the patients' clinical records and pre- and postoperative case notes, diagnostic and intraoperative images. There were 97 (giant 43, big 54) ICA aneurysms, 105 (giant 45, big 60) MC aneurysms and 32 (giant 7, big 25) AC aneurysms, 25 (giant 14, big 11) VB aneurysms. All patients underwent thorough pre-surgical planning of approach and clipping technique.Surgical technique involved the use of multiple clips with the initial clip securing the deepest neck part and the others successively occluding the rest by remnant clips, occluding along the best plane of neck obliteration.
Out of 193 cases, 165 cases were without any complications. Temporary complications were seen in 18 cases and permanent in 10. In our 65 ruptured aneurysms operated on, outcome was in line with standard outcome according to the SAH grade on admission (H&H, WFNS grade). In total, 183 cases had good results (94.8%).
The "multi" clip method for the treatment of complex intracranial aneurysms can be a safe and effective method where a single clip cannot obtain complete neck closure. Proper preoperative understanding of the three-dimensional anatomy of the aneurysm and appropriate preoperative planning and selection of suitable clipping method, using an appropriate combination of clips, definitely can reduce the morbidity and mortality in these patients.
评估多重夹闭术治疗复杂颅内动脉瘤的疗效，分析我院夹闭的大型和巨大型脑动脉瘤的技术及治疗结果。
1975年1月至2008年12月期间，藤田保健大学医院共对259例大型和巨大型颅内动脉瘤（65例破裂，193例未破裂）进行了夹闭治疗。所有患者均根据我们的多重夹闭技术并重建载瘤血管，采用多重夹闭术进行治疗。所有患者术前行三维计算机断层扫描，部分患者还接受了数字减影血管造影。我们检查了患者的临床记录以及术前和术后病历、诊断和术中影像。其中有97例（巨大型43例，大型54例）颈内动脉瘤，105例（巨大型45例，大型60例）大脑中动脉瘤，32例（巨大型7例，大型25例）前交通动脉瘤，25例（巨大型14例，大型11例）椎动脉动脉瘤。所有患者均进行了全面的术前入路及夹闭技术规划。手术技术包括使用多个夹子，最初的夹子固定在最深的瘤颈部位，其他夹子则通过剩余夹子依次夹闭其余部分，沿最佳瘤颈闭塞平面进行夹闭。
193例患者中，165例无任何并发症。18例出现临时并发症，10例出现永久性并发症。在我们手术治疗的65例破裂动脉瘤中，根据入院时蛛网膜下腔出血分级（H&H分级、WFNS分级），治疗结果符合标准。总体而言，183例患者治疗效果良好（94.8%）。
对于复杂颅内动脉瘤，当单个夹子无法实现完全瘤颈夹闭时，“多重”夹闭法可能是一种安全有效的方法。术前对动脉瘤的三维解剖结构有充分了解，进行适当的术前规划并选择合适的夹闭方法，合理组合使用夹子，肯定可以降低这些患者的发病率和死亡率。
