Sato Yosuke, Samii Madjid
Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
Department of Neurosurgery, Cerebrovascular Center, Niigata Rosai Hospital, Japan Organization of Occupational Health and Safety, Niigata, Japan.
Surg Neurol Int. 2017 Dec 6;8:292. doi: 10.4103/sni.sni_326_17. eCollection 2017.
Giant thrombosed aneurysms often present with thickened walls and a hard thrombus, including in the near-neck aneurysmal sac. These usually make it difficult to achieve complete neck clipping with preservation of local branch patency. Here, we demonstrate a simple but safe and effective technique to overcome these problems in a patient with a 6-cm giant thrombosed distal anterior cerebral artery aneurysm.
A 77-year-old-man suffered from loss of volitional activity due to the frontal mass effect. The aneurysm was exposed with unilateral paramedian craniotomy and an interhemispheric approach. The clip was applied to the aneurysmal neck but it slipped onto the parent artery, which caused branch artery occlusion. Intra-aneurysmal thrombectomy was immediately performed near the aneurysmal neck with ultrasonic aspiration. The next clip was added along the aneurysm side of the preceding clip, which was then removed. This procedure was repeated twice so that complete neck clipping was achieved while preserving the branch patency. All the residual thrombus and aneurysmal wall were subsequently removed. Postoperatively, there was no additional neurological deficit. The patient's mental function was significantly improved.
We conclude that the sequential, progressive clipping technique is a robust option for successful neck clipping of giant thrombosed aneurysms.
巨大血栓性动脉瘤常表现为瘤壁增厚且有坚硬血栓，包括在瘤颈附近的瘤囊内。这些情况通常使得在保留局部分支通畅的情况下难以实现完全瘤颈夹闭。在此，我们展示一种简单但安全有效的技术，用于在一名患有6厘米巨大血栓性大脑前动脉远端动脉瘤的患者中克服这些问题。
一名77岁男性因额叶占位效应出现意志活动丧失。通过单侧旁正中开颅和半球间入路暴露动脉瘤。将夹子应用于动脉瘤颈部，但夹子滑到了载瘤动脉上，导致分支动脉闭塞。立即在动脉瘤颈部附近用超声吸引进行瘤内血栓切除术。沿着前一个夹子的动脉瘤侧添加下一个夹子，然后移除前一个夹子。这个过程重复了两次，从而在保留分支通畅的同时实现了完全瘤颈夹闭。随后切除了所有残留血栓和动脉瘤壁。术后，没有出现额外的神经功能缺损。患者的精神功能有显著改善。
我们得出结论，序贯渐进夹闭技术是成功夹闭巨大血栓性动脉瘤瘤颈的一种可靠选择。
