Senko Ilya, Shatokhin Anton, Bishnoi Ishu, Yamada Yasuhiro, Tanaka Riki, Suyama Daisuke, Kawase Tukasa, Kato Yoko
Department of Neurosurgery, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia.
Department of Neurosurgery, Stavropol Emergency Hospital, Stavropol, Russia.
Asian J Neurosurg. 2018 Apr-Jun;13(2):496-498. doi: 10.4103/ajns.AJNS_359_16.
Intraoperative aneurysmal rupture (IAR) is the most fearsome complication of aneurysm surgery. IAR associates with high morbidity and mortality. In recent years, we have many studies regarding using computational fluid dynamics (CFD) in aneurysm surgery. CFD helps in calculating the velocity of blood flowing in the aneurysm sac, the pressure in the aneurysm sac, and wall shear stress (WSS). CFD also helps in predicting nature of aneurysm wall and thus may warn about different intraoperative microscopy findings in aneurysms. Using its application, surgeon may become more careful in doing microsurgical sharp dissection. A 40-year-old female admitted with diagnosis of unruptured anterior communicating artery aneurysm. CFD analysis demonstrated high intra-aneurysmal pressure and divergent WSS in dome. During sharp dissection, there was intraoperative rupture aneurysm twice which was managed with cotton tamponade and glue and temporary clipping aneurysm. Indocyanine green video angiography showed working parent arteries and nonfunctioning aneurysm. After operation, the patient recovered fully and had a modified Rankin score of 1. This case demonstrated importance of preoperative planning of aneurysm surgery using CFD analysis. IAR is associated with an increased risk for an unfavorable outcome. Accurate preoperative planning with studying flow dynamics and structure of aneurysm may help in use sharp microsurgical dissection more cautiously.
术中动脉瘤破裂（IAR）是动脉瘤手术最可怕的并发症。IAR与高发病率和死亡率相关。近年来，我们有许多关于在动脉瘤手术中使用计算流体动力学（CFD）的研究。CFD有助于计算动脉瘤腔内的血流速度、动脉瘤腔内的压力以及壁面剪应力（WSS）。CFD还有助于预测动脉瘤壁的性质，从而可能警示动脉瘤术中不同的显微镜下表现。通过其应用，外科医生在进行显微外科锐性分离时可能会更加小心。一名40岁女性因诊断为未破裂的前交通动脉瘤入院。CFD分析显示动脉瘤腔内压力高且瘤顶处WSS呈发散状。在锐性分离过程中，动脉瘤术中破裂两次，通过棉片填塞、胶水和临时夹闭动脉瘤进行处理。吲哚菁绿视频血管造影显示供血动脉正常且动脉瘤无功能。术后，患者完全康复，改良Rankin评分为1分。该病例证明了使用CFD分析进行动脉瘤手术术前规划的重要性。IAR与不良预后风险增加相关。通过研究动脉瘤的血流动力学和结构进行准确的术前规划，可能有助于更谨慎地使用显微外科锐性分离。
