Figueiredo Eberval Gadelha, Foroni Luciano, Monaco Bernardo Assumpção de, Gomes Marcos Q T, Sterman Neto Hugo, Teixeira Manoel Jacobsen
Division of Neurological Surger, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Arq Neuropsiquiatr. 2010 Feb;68(1):115-8. doi: 10.1590/s0004-282x2010000100024.
Fusiform and dolichoectatic aneurysms are challenging lesions to treat with direct clipping. Treatment of these aneurysms often requires alternative surgical strategies, including extracranial-intracranial bypass, wrapping, or clip-wrap techniques. Nonetheless, these alternatives methods of treatment have been underused and frequently overlooked.
To report a series of nine cases of otherwise untreatable aneurysms managed using the clip-wrap technique and discuss its surgical nuances.
In the last four years, 9 cases of ruptured aneurysms treated by the clip-wrap techniques were identified in the Division of Neurological Surgery, University of São Paulo, School of Medicine.
The aneurysms were located at middle cerebral artery (2), anterior choroidal artery (1), anterior communicating artery (1), carotid ophthalmic (3), posterior cerebral artery (1) and posterior-inferior cerebellar artery (1). Three were dolichoectatic, 4 were unsuitable to complete surgical clipping because parent or efferent vessels arises from the aneurysm sac (1 MCA, 1 AcomA, 1 CO, 1 PICA aneurysms) and two, although ruptured aneurysms, were too small (<2mm) to be directly clipped. No early or late rebleeding was observed after 2 years mean follow-up. One patient deceased due to pulmonary tromboembolism.
Clip-wrap techniques for the treatment of fusiform and otherwise unclippable aneurysms seem to be safe and it can be associated with a low rate of acute or delayed postoperative complications. It can prevent rebleeding and represents an improvement when compared with the natural history.
梭形和迂曲扩张型动脉瘤是直接夹闭治疗具有挑战性的病变。这些动脉瘤的治疗通常需要替代手术策略，包括颅外-颅内搭桥、包裹或夹闭-包裹技术。尽管如此，这些替代治疗方法一直未得到充分利用且经常被忽视。
报告一系列9例使用夹闭-包裹技术治疗的其他方法无法治疗的动脉瘤病例，并讨论其手术细节。
在过去四年中，圣保罗大学医学院神经外科识别出9例采用夹闭-包裹技术治疗的破裂动脉瘤病例。
动脉瘤位于大脑中动脉（2例）、脉络膜前动脉（1例）、前交通动脉（1例）、颈内动脉眼动脉段（3例）、大脑后动脉（1例）和小脑后下动脉（1例）。3例为迂曲扩张型，4例因载瘤动脉或传出血管起源于动脉瘤囊（1例大脑中动脉、1例前交通动脉、1例颈内动脉眼动脉段、1例小脑后下动脉动脉瘤）而不适合完全夹闭，2例尽管是破裂动脉瘤，但太小（<2mm）无法直接夹闭。平均随访2年后未观察到早期或晚期再出血。1例患者因肺血栓栓塞死亡。
夹闭-包裹技术治疗梭形及其他无法夹闭的动脉瘤似乎是安全的，且术后急性或延迟并发症发生率较低。它可以预防再出血，与自然病程相比是一种进步。
