Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
Neurosurgery. 2010 Mar;66(3 Suppl Operative):84-7; discussion 87. doi: 10.1227/01.NEU.0000348008.89027.C1.
OBJECTIVE: Recurrences after complete surgical clipping of an aneurysm base are rare. We describe a potential reason for such recurrences: the inappropriate application of a popular aneurysm clip. CLINICAL PRESENTATION: We present 3 cases in which intraoperative indocyanine green video angiography after clipping clearly demonstrates filling of the aneurysm. INTERVENTION: During surgery, the necks of the aneurysms were clipped with Yaşargil aneurysm clips (Aesculap AG & Co., Tuttlingen, Germany) without any problems; however, indocyanine green video angiography after clipping showed filling of the aneurysms through the point located at the junction of the blade and spring portions of the clips. In the first patient, the aneurysm sac was further coagulated, and a second, smaller clip was applied to completely occlude the untreated part. In the second patient, the clip was replaced with a different clip that had longer blades. In the third patient, 2 additional clips were applied, and the aneurysm sac was also coagulated. The postoperative computed tomographic angiographic examinations showed total occlusion of the aneurysms and patency of the parent arteries. All patients achieved full recovery after the operations. CONCLUSION: We present here, for the first time, evidence that the small orifice located at the junction of the blade and spring portions of Yaşargil aneurysm clips can lead to failure of initial surgery and/or recurrence. This can be avoided by using clips with slightly longer blades to keep the orifice away from the aneurysm or by applying a second clip to occlude the untreated part.
目的:动脉瘤基底完全手术夹闭后复发较为罕见。我们描述了一种导致这种复发的潜在原因:一种流行的动脉瘤夹的不当应用。
临床描述:我们介绍了 3 例病例,术中夹闭后吲哚菁绿视频血管造影清楚地显示了动脉瘤的充盈。
干预措施:在手术中,用 Yasargil 动脉瘤夹(Aesculap AG & Co.,Tuttlingen,德国)无问题地夹闭动脉瘤颈;然而,夹闭后的吲哚菁绿视频血管造影显示动脉瘤通过夹片的叶片和弹簧部分交界处的点充盈。在第一个患者中,进一步凝固动脉瘤囊,并用第二个较小的夹子完全闭塞未治疗的部分。在第二个患者中,更换了更长叶片的另一个夹子。在第三个患者中,应用了另外两个夹子,并且也凝固了动脉瘤囊。术后 CT 血管造影检查显示动脉瘤完全闭塞,载瘤动脉通畅。所有患者术后均完全恢复。
结论:我们首次提出证据表明,Yasargil 动脉瘤夹叶片和弹簧部分交界处的小孔可能导致初次手术失败和/或复发。通过使用叶片稍长的夹子使孔远离动脉瘤,或者应用第二个夹子闭塞未治疗的部分,可以避免这种情况。
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