Murai Yasuo, Adachi Koji, Matano Fumihiro, Takagi Ryo, Amano Yasuo, Kobayashi Shiro, Kitamura Takayuki, Teramoto Akira
Nippon Medical School, Department of Neurosurgery, Tokyo, Japan.
Turk Neurosurg. 2013;23(6):772-7. doi: 10.5137/1019-5149.JTN.7886-13.1.
Replacement of aneurysm clips or temporary parent artery occlusion during aneurysm clipping (AC) carries the risk of inducing postoperative neurologic deficits. When studying the risk of surgical complications associated with cerebral aneurysms, patients with similar conditions should be compared to eliminate the influence of rupture and location of aneurysm.
We used 3.0-Tesla (3.0T) magnetic resonance diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) to analyze surgical complications after AC. A total of 42 AC procedures for 40 unruptured and 2 delayed-phase ruptured MCA aneurysms were evaluated.
In six patients, temporary parent artery occlusion was performed. Asymptomatic hyperintensities were observed on DWI of three patients. In one patient, an asymptomatic lesion was most likely caused by a small contusion that occurred during dissection of an aneurysm attached to the brain surface. In two patients, asymptomatic cortical lesions were caused by brain surface contusions due to lacerations of the open dura. No symptomatic hyperintensities on DWI were observed after surgery. No fixed ischaemic neurologic deficits resulted from AC.
Although some postoperative abnormalities were observed with 3.0T DWI, we found clipping of MCA aneurysms to be a safe procedure with a low risk of ischaemic complications.
在动脉瘤夹闭术（AC）期间更换动脉瘤夹或临时阻断载瘤动脉存在诱发术后神经功能缺损的风险。在研究与脑动脉瘤相关的手术并发症风险时，应比较病情相似的患者，以消除动脉瘤破裂和位置的影响。
我们使用3.0特斯拉（3.0T）磁共振扩散加权成像（DWI）和磁共振血管造影（MRA）分析AC术后的手术并发症。对40例未破裂和2例延迟期破裂的大脑中动脉（MCA）动脉瘤进行了总共42次AC手术。
6例患者进行了临时载瘤动脉阻断。3例患者的DWI上观察到无症状高信号。1例患者的无症状病变很可能是由于在解剖附着于脑表面的动脉瘤时发生的小挫伤所致。2例患者的无症状皮质病变是由于开放硬脑膜撕裂导致的脑表面挫伤所致。术后未观察到DWI上有症状性高信号。AC未导致固定的缺血性神经功能缺损。
尽管3.0T DWI观察到一些术后异常，但我们发现MCA动脉瘤夹闭术是一种安全的手术，缺血性并发症风险低。
