Yamada Yasuhiro, Kato Yoko, Ishihara Kohei, Ito Keisuke, Kaito Takafumi, Nouri Mohsen, Oheda Motoki, Inamasu Joji, Hirose Yuichi
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
Asian J Neurosurg. 2015 Jan-Mar;10(1):52. doi: 10.4103/1793-5482.151518.
Unruptured aneurysm surgery is a challenge to all vascular neurosurgeons as the patient is asymptomatic and no even slight neurological deficits should be expected postoperatively. To this aim, multi-modality checking of the vessels during the surgery is highly recommended to assure of the patency of the parent and perforator arteries next to an aneurysm. In this paper, we present our experience in the last 1.5 years with emphasis on the role of endoscope assisted microsurgery.
One hundred and seventy-five patients with unruptured intracranial aneurysms were operated in our institute in the last 1½ years. All patients underwent endoscope assisted microsurgery with pre- and post-clipping indocyanine green angiography. In selected cases, motor evoked potential monitoring was implemented.
No mortality was observed in this period, and only 6 patients (3.4%) suffered new permanent neurological deficits postoperatively. Our illustrative cases show how endoscopy may help the surgeon to visualize hidden vessels behind and medial to an aneurysm.
Our results indicated that multi-modality monitoring during unruptured aneurysm surgeries is associated with excellent outcome. Endoscope is able to show blind corners during aneurysm surgery which cannot be routinely observed with microscope and its application in aneurysm surgery assists the surgeon to make certain of complete neck clipping and preservation of perforating arteries around the aneurysm.
未破裂动脉瘤手术对所有血管神经外科医生而言都是一项挑战，因为患者无症状，且术后不应预期出现哪怕轻微的神经功能缺损。为此，强烈建议在手术过程中对血管进行多模态检查，以确保动脉瘤旁供血动脉和穿支动脉的通畅。在本文中，我们介绍过去1.5年的经验，重点强调内镜辅助显微手术的作用。
在过去1.5年中，我们研究所为175例未破裂颅内动脉瘤患者实施了手术。所有患者均接受了内镜辅助显微手术，并在夹闭前后进行了吲哚菁绿血管造影。在部分病例中，实施了运动诱发电位监测。
在此期间未观察到死亡病例，仅有6例患者（3.4%）术后出现新的永久性神经功能缺损。我们的典型病例展示了内镜如何帮助外科医生看清动脉瘤后方和内侧隐藏的血管。
我们的结果表明，未破裂动脉瘤手术中的多模态监测与良好的预后相关。内镜能够显示动脉瘤手术中显微镜无法常规观察到的死角，其在动脉瘤手术中的应用有助于外科医生确保完全夹闭瘤颈并保留动脉瘤周围的穿支动脉。
