Acciarri Nicola, Toniato Giovanni, Raabe Andreas, Lanzino Giuseppe
Department of Neurosurgery, IRCCS, Bellaria Hospital, Bologna, Italy -
J Neurosurg Sci. 2016 Mar;60(1):83-94. Epub 2015 Dec 2.
The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms.
脑动脉瘤手术的历史极大地归功于开拓性神经外科医生的坚韧不拔，他们设计并开发了用于夹闭动脉瘤颈部的夹子。然而，直到上个世纪初，由于缺乏手术显微镜和市售的精密夹子，复杂且具有挑战性的动脉瘤手术是不可能的。弹簧夹的现代时代始于上世纪下半叶。在此之前，颅内动脉瘤仅可使用可锻金属夹和其他非金属材料。的确，最早的夹子危险且难以操作。几位神经外科医生根据他们治疗脑动脉瘤的个人经验，致力于开发新的夹子模型。最后，手术显微镜的引入以及更精密夹子的出现，使得复杂且具有挑战性的动脉瘤得以治疗。然而，如今，如果不铭记伟大的神经血管外科医生所提供的关于创新手术技术的经验教训，动脉瘤手术治疗的任何新器械或工具都无法安全有效地使用。多亏了他们的传承，我们现在能够治疗许多一直被认为无法手术的动脉瘤类型。在本文中，我们回顾手术夹闭的基本原则，并阐述一些用于复杂动脉瘤的更先进技术。
