Department of Neurosurgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
Department of Neurosurgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
World Neurosurg. 2018 Jun;114:113-116. doi: 10.1016/j.wneu.2018.03.053. Epub 2018 Mar 14.
We describe the technique for surgical "transaneurysmal" embolectomy in a patient with subarachnoid hemorrhage and multiple cerebral aneurysms who manifested large-vessel occlusion during coil embolization.
An 84-year-old woman with subarachnoid hemorrhage and bilateral internal carotid artery (ICA)-posterior communicating artery and bilateral middle cerebral artery aneurysms (MCAs) was admitted to our institution. We performed clipping to the left ICA and MCAs; however, we could not find the rupture point of both aneurysms. We chose to treat 2 aneurysms on the other side by coil embolization. After complete coil embolization of a right ICA aneurysm, angiograms showed occlusion of the right MCA just proximal to an MCA aneurysm. Considering the risk of bleeding of an untreated MCA distal to the occlusion by endovascular thrombectomy, we performed open transaneurysmal embolectomy at the occlusion site and surgical clipping of the MCA. After cutting the aneurysmal wall, we inserted a suction tube into the cut surface of the aneurysm. The clot was gradually and completely pulled through the cut surface of the aneurysm. Finally, the aneurysm was completely clipped with titanium clips to preserve the M1 and M2 branches.
Different from usual surgical thrombectomy, suturing the vessel wall is not required for transaneurysmal embolectomy and the area of brain ischemia is confined. Aneurysms with the fragile wall may rupture during clearance of tissue on the aneurysmal surface, and suction may increase vessel damage.
Transaneurysmal thrombectomy may be useful and safe for large-vessel occlusion just distal to cerebral aneurysms.
我们描述了一种在蛛网膜下腔出血和多个脑动脉瘤患者中进行的手术“跨动脉瘤”取栓的技术，该患者在进行线圈栓塞时表现出大血管闭塞。
一名 84 岁女性因蛛网膜下腔出血和双侧颈内动脉（ICA）-后交通动脉瘤以及双侧大脑中动脉动脉瘤（MCA）而入院。我们对左侧 ICA 和 MCA 进行了夹闭，但未能找到两个动脉瘤的破裂点。我们选择通过线圈栓塞治疗另一侧的两个动脉瘤。在完全栓塞右侧 ICA 动脉瘤后，血管造影显示右侧 MCA 在 MCA 动脉瘤近端发生闭塞。考虑到通过血管内血栓切除术对未治疗的 MCA 远端出血的风险，我们在闭塞部位进行了开颅跨动脉瘤取栓术，并对 MCA 进行了外科夹闭。切开动脉瘤壁后，我们将吸管插入动脉瘤的切面。血栓逐渐并完全通过动脉瘤的切面被抽出。最后，用钛夹完全夹闭动脉瘤，以保留 M1 和 M2 分支。
与通常的手术取栓不同，跨动脉瘤取栓不需要缝合血管壁，且脑缺血面积受限。在清除动脉瘤表面的组织时，脆弱的动脉瘤壁可能会破裂，并且抽吸可能会增加血管损伤。
对于大脑动脉瘤远端的大血管闭塞，跨动脉瘤取栓可能是有用且安全的。
