Takeuchi Kazuhito, Handa Takashi, Chu Jonsu, Wada Kentaro, Wakabayashi Toshihiko
1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya City, Aichi; and.
2Department of Neurosurgery, Tokoname Municipal Hospital, Tokoname City, Aichi, Japan.
J Neurosurg. 2019 Jul 1;131(1):104-108. doi: 10.3171/2018.1.JNS172393. Epub 2018 Jul 6.
Intraventricular hemorrhage and intracerebral aneurysms are relatively frequent complications associated with moyamoya disease. Prevention of aneurysm rerupture is important because it significantly decreases the morbidity and mortality rates. Aneurysms arising distal to collateral flow are sometimes observed in patients with intraventricular hemorrhage; however, the treatment of these aneurysms remains challenging because of their deep-seated location in the brain and accompanying narrow surgical corridor. The authors describe a neuroendoscopic aneurysm clipping technique performed in 2 cases using a small-diameter tubular retractor for intraventricular aneurysms of the distal lateral posterior choroidal artery. In this technique, the surgical field was continuously irrigated with artificial CSF to keep the ventricle size intact, and aneurysm clipping was performed through a tubular retractor that was introduced with neuronavigational guidance. The patients' postoperative courses were uneventful, and CT angiography revealed complete clipping of the aneurysms and patent parent arteries. Endoscopic clipping using a tubular retractor is an effective and less invasive alternative for treating intraventricular aneurysms. The wet-field endoscopic technique is performed in an aqueous field and maintains an intact ventricle size, allowing for a clear surgical view and a wider, enhanced surgical field.
脑室内出血和脑内动脉瘤是烟雾病相对常见的并发症。预防动脉瘤再破裂很重要，因为这能显著降低发病率和死亡率。脑室内出血患者有时会出现侧支血流远端的动脉瘤；然而，由于这些动脉瘤位于脑深部且手术通道狭窄，其治疗仍然具有挑战性。作者描述了一种神经内镜动脉瘤夹闭技术，该技术在2例患者中使用小直径管状牵开器用于脉络膜后外侧动脉远端的脑室内动脉瘤。在该技术中，用人工脑脊液持续冲洗手术视野以保持脑室大小完整，并通过在神经导航引导下引入的管状牵开器进行动脉瘤夹闭。患者术后病程平稳，CT血管造影显示动脉瘤完全夹闭且供血动脉通畅。使用管状牵开器进行内镜夹闭是治疗脑室内动脉瘤的一种有效且侵入性较小的替代方法。湿场内镜技术在含水环境中进行，保持脑室大小完整，可提供清晰的手术视野和更宽、更好的手术区域。
