Department of Neurological Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Department of Internal Medicine, division of Epidemiology, Biostatistics and Preventive Medicine University of New Mexico School of Medicine, Albuquerque, New Mexico.
Oper Neurosurg (Hagerstown). 2018 Oct 1;15(4):440-446. doi: 10.1093/ons/opx278.
Middle cerebral artery (MCA) aneurysms continue to be viewed by many as primarily surgical entities.
To introduce a new, easily measurable dimension termed "neck overhang," defined as the amount of the aneurysm that extends proximal to the 2 dimensionally defined "neck" and to evaluate the utility of the intersecting clipping technique (use of straight clip and intersecting fenestrated clip) to adapt to this overhanging segment's specific dimensions and achieve better obliteration of the MCA aneurysms.
We reviewed retrospectively 100 MCA aneurysms treated surgically over the last 10 yr at our institution. We identified the clipping technique that was performed (intersecting vs "standard" technique) and we evaluated the presence of a postoperative remnant. We then correlated these with the aneurysm's overhanging neck length.
Forty-three aneurysms were treated with the intersecting clipping technique. The overall rate of remnant was 16%. In the standard group, the rate of remnant was 23%, whereas with intersecting clipping that was 7% (P = .029). Within the standard clipping group, we found that the optimum threshold for length of the neck overhang was ≥1.9 mm in order to predict the occurrence of residual. Applying this threshold to the intersecting clipping technique group resulted in a reduction in remnant from 35% in the standard group to 9%.
Neck overhang >1.9 mm is associated with a higher chance of postclipping residual aneurysm in MCA aneurysms. The intersecting clipping technique is a versatile technique that can conform to various aneurysms' geometry and can reduce the rate of post clipping residual for aneurysms with high neck overhang.
许多人仍然认为大脑中动脉（MCA）动脉瘤主要是手术治疗的。
引入一个新的、易于测量的维度，称为“颈突”，定义为动脉瘤延伸到二维定义的“颈部”近端的量，并评估交叉夹闭技术（使用直夹和交叉开窗夹）的实用性，以适应这个突出段的特定尺寸，并更好地闭塞 MCA 动脉瘤。
我们回顾性分析了过去 10 年来我院 100 例 MCA 动脉瘤的手术治疗情况。我们确定了使用的夹闭技术（交叉 vs“标准”技术），并评估了术后残腔的存在。然后，我们将这些与动脉瘤的突出颈长相关联。
43 例动脉瘤采用交叉夹闭技术治疗。总的残余率为 16%。在标准组中，残余率为 23%，而交叉夹闭组为 7%（P=0.029）。在标准夹闭组中，我们发现颈突长度的最佳阈值为≥1.9mm，以预测残余的发生。将此阈值应用于交叉夹闭技术组，可将标准组的残余率从 35%降低至 9%。
MCA 动脉瘤颈突>1.9mm 与夹闭后残余动脉瘤的几率增加相关。交叉夹闭技术是一种通用的技术，可以适应各种动脉瘤的几何形状，并降低颈突较高的动脉瘤的夹闭后残余率。
