Park Wonhyoung, Ahn Jae Sung, Park Jung Cheol, Kwon Do Hoon, Kwun Byung Duk, Kim Chang Jin
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
Acta Neurochir (Wien). 2014 May;156(5):869-77. doi: 10.1007/s00701-014-2059-z. Epub 2014 Mar 30.
Unplanned re-exploration of the craniotomy after surgical treatment of unruptured intracranial aneurysms (UIAs) is sometimes required, but the underlying causes and rates of these procedures are seldom reported. This study retrospectively analyzed the causes of such re-explorations to identify methods for decreasing their necessity.
From January 2000 to December 2011, 1,720 patients with a total of 1,938 UIAs underwent surgical treatment at our institution. From this cohort, 26 patients (1.5 %) with 38 UIAs required re-exploration. Clinical data, aneurysm characteristics, treatment methods, and the incidence and causes of re-exploration of the craniotomy were analyzed for these 26 patients.
Several causes of re-exploration were identified: compromised distal blood flow (eight patients, 0.47 %), hemorrhagic venous infarction (four patients, 0.23 %), brain retraction injury (three patients, 0.17 %), newly identified aneurysms (three patients, 0.17 %), bleeding from an incompletely clipped aneurysm (two patients, 0.12 %), epidural hematoma (two patients, 0.12 %), failed aneurysm clipping (two patients, 0.12 %) and other causes (two patients, 0.12 %). Annual re-exploration incidence rates ranged from 0 to 3.1 %. Annual incidence rates gradually decreased following the introduction of several intraoperative monitoring systems.
Precise surgical planning and careful operative techniques can reduce the incidence of unplanned re-exploration of the craniotomy. The introduction of various intraoperative monitoring systems can also contribute to a reduction in this incidence.
未破裂颅内动脉瘤（UIA）手术治疗后有时需要进行计划外的开颅再次探查，但这些手术的潜在原因和发生率鲜有报道。本研究回顾性分析此类再次探查的原因，以确定减少其必要性的方法。
2000年1月至2011年12月，我院共1720例患者的1938个UIA接受了手术治疗。在该队列中，26例（1.5%）患者的38个UIA需要再次探查。分析这26例患者的临床资料、动脉瘤特征、治疗方法以及开颅再次探查的发生率和原因。
确定了几种再次探查的原因：远端血流受损（8例，0.47%）、出血性静脉梗死（4例，0.23%）、脑牵拉损伤（3例，0.17%）、新发现的动脉瘤（3例，0.17%）、夹闭不完全的动脉瘤出血（2例，0.12%）、硬膜外血肿（2例，0.12%）、动脉瘤夹闭失败（2例，0.12%）以及其他原因（2例，0.12%）。每年的再次探查发生率为0至3.1%。引入几种术中监测系统后，年发生率逐渐下降。
精确的手术规划和仔细的手术技术可降低开颅计划外再次探查的发生率。引入各种术中监测系统也有助于降低这一发生率。
