Hage Ziad A, Charbel Fady T
Department of Neurosurgery, University of Illinois at Chicago.
Neurosurg Focus. 2015 Jan;38(VideoSuppl1):Video19. doi: 10.3171/2015.V1.FOCUS14604.
We showcase the microsurgical clipping of a left middle cerebral artery (MCA) aneurysm-(B) done through a modified right lateral supraorbital craniotomy, as well as clipping of a previously coiled anterior communicating (ACOM) artery aneurysm-(C) and a bilobed right MCA aneurysm-(A). Splitting of the right sylvian fissure is initially performed following which a subfrontal approach is used to expose and dissect the contralateral sylvian fissure. The left MCA aneurysm is identified and clipped. The ACOM aneurysm is then clipped following multiple clip repositioning based on flow measurements. The right MCA aneurysm is then identified and each lobe is clipped separately. The first picture showcased in this video is a side to side right and left ICA injection in AP projection. In this picture, (A) points to the bilobed right MCA aneurysm, (B) to the left middle cerebral artery (MCA) aneurysm, and (C) to the previously coiled anterior communicating (ACOM) artery aneurysm. The red dotted line shows that both MCA aneurysms lie within the same plane which makes it easier to clip both of them, through one small craniotomy. The video can be found here: http://youtu.be/4cQC7nHsL5I .
我们展示了通过改良的右侧眶上开颅术对左侧大脑中动脉（MCA）动脉瘤（图B）进行的显微手术夹闭，以及对先前已栓塞的前交通（ACOM）动脉动脉瘤（图C）和双叶状右侧MCA动脉瘤（图A）的夹闭。首先进行右侧外侧裂劈开，然后采用额下入路暴露并解剖对侧外侧裂。识别并夹闭左侧MCA动脉瘤。然后根据血流测量结果多次重新放置夹子后夹闭ACOM动脉瘤。接着识别右侧MCA动脉瘤并分别夹闭每个叶。本视频展示的第一张图片是前后位投照下左右颈内动脉（ICA）的双侧注射。在这张图片中，（A）指向双叶状右侧MCA动脉瘤，（B）指向左侧大脑中动脉（MCA）动脉瘤，（C）指向先前已栓塞的前交通（ACOM）动脉动脉瘤。红色虚线表明两个MCA动脉瘤位于同一平面，这使得通过一个小的开颅术更容易夹闭它们。视频可在此处找到：http://youtu.be/4cQC7nHsL5I 。
