Department of Neurosurgery, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany.
Neurosurgery. 2010 Jun;66(6 Suppl Operative):336-8. doi: 10.1227/01.NEU.0000369644.26132.56.
BACKGROUND: Currently, there is an ongoing debate regarding the best treatment option for ruptured aneurysms. The International Subarachnoid Aneurysm Trial study suggests that an endovascular procedure is the best treatment. In some complex cases, or in patients with an additional large intracerebral hemorrhage, aneurysms require further microsurgical clipping. OBJECTIVE: We introduce a new clip system to improve clipping procedures in especially complex aneurysms. METHODS: The inverted opening mechanism of the clip in combination with the special clip applier provides the surgeon with a good overview in the operating field. The new design also enables a wider opening of the clip jaws in contrast to all other well-known titanium aneurysm clips. This should provide a better and safer application and decrease the danger of premature rupture. RESULTS: From January 2006 to July 2008, 55 aneurysms were clipped in 45 patients. The most common aneurysm location was the anterior communicating artery (20 patients) followed by the M1 segment of the middle cerebral artery (16 patients). Four patients had 2, one had 3, and one had 5 aneurysms. Two clipping procedures were performed for an arteriovenous malformation-associated aneurysm. All aneurysms were clipped without any technical complication. CONCLUSION: The use of the new clip system, especially in complex aneurysm surgery, has potential benefits because of the better surgical vision during clip application and the wider opening of the clip jaws. It is easy to handle and compatible with magnetic resonance imaging.
背景:目前,对于破裂的动脉瘤,哪种治疗方法最佳,仍存在争议。国际蛛网膜下腔出血试验研究表明血管内治疗是最佳的治疗方法。但在一些复杂病例中,或者在患者有另一个大的脑内血肿时,动脉瘤需要进一步的显微镜夹闭手术。
目的:我们引入一种新的夹闭系统,以改善尤其复杂动脉瘤的夹闭手术。
方法:夹闭的反向开口机制与特殊的夹闭器相结合,为外科医生提供了良好的手术视野。与所有其他知名的钛制动脉瘤夹相比,这种新设计还可以使夹闭器的钳口更宽地张开。这应该可以提供更好、更安全的应用,降低动脉瘤过早破裂的危险。
结果:从 2006 年 1 月至 2008 年 7 月,45 例患者中的 55 个动脉瘤接受了夹闭手术。最常见的动脉瘤位置是前交通动脉(20 例),其次是大脑中动脉 M1 段(16 例)。有 4 例患者有 2 个动脉瘤,1 例患者有 3 个动脉瘤,1 例患者有 5 个动脉瘤。2 例夹闭手术是为动静脉畸形相关的动脉瘤进行的。所有的动脉瘤均无任何技术并发症而被夹闭。
结论:由于在夹闭器应用过程中具有更好的手术视野和更宽的夹闭器钳口张开度,因此使用新的夹闭系统,尤其是在复杂的动脉瘤手术中,具有潜在的益处。它易于操作,与磁共振成像兼容。
Acta Neurochir (Wien). 2010-6-17
Surg Neurol Int. 2023-6-16