Choque-Velasquez Joham, Hernesniemi Juha
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China.
Surg Neurol Int. 2018 Sep 10;9:185. doi: 10.4103/sni.sni_261_18. eCollection 2018.
In this video abstract, we present an intradural anterior clinoidectomy for management of some paraclinoid aneurysms. Quick adenosine cardiac arrest performed instead of an anterior clinoidectomy and proximal temporary clipping usually allows us a proximal control of aneurysms in Helsinki Neurosurgery. However, when the neck of the aneurysm remains hidden under the anterior clinoid process, or when some complex aneurysms have reduced space for placing temporary clips obstructing the definitive clipping, anterior clinoidectomy is the most available option.
The patient with multiple intracranial aneurysms had a ruptured anterior cerebral artery aneurysm associated with a right middle cerebral artery aneurysm and a right small paraclinoid aneurysm. The patient underwent surgical clipping of all aneurysms by a right lateral supraorbital approach at one-stage surgery. After the associated aneurysms were clipped, the hidden paraclinoid aneurysm required an anterior clinoidectomy for definitive clipping. A small durotomy over the anterior clinoid process was made with microscissors after bipolar coagulation. Subsequently, the anterior clinoidectomy was performed under visual control with the use of an electric high-speed diamond drill (3 mm diameter). The direction and size of the drilling were performed according to the anatomical configuration and exact location of the aneurysm determined by the preoperative radiological analysis of the case. A definitive clip was applied after complete visualization of aneurysm. Postoperative computed tomography angiography demonstrated absence of complications.
Anterior clinoidectomy is a useful procedure aiming at a proper definitive clipping of paraclinoid aneurysms with challenging locations and configurations.
http://surgicalneurologyint.com/videogallery/right-clinoidectomy/.
在本视频摘要中，我们展示了一种用于治疗某些床突旁动脉瘤的硬膜内前床突切除术。在赫尔辛基神经外科，我们采用快速腺苷心脏骤停而非前床突切除术和近端临时夹闭术，通常能实现对动脉瘤的近端控制。然而，当动脉瘤颈部隐藏在前床突下方，或者一些复杂动脉瘤放置临时夹的空间减小，阻碍了最终夹闭时，前床突切除术是最可行的选择。
该患有多个颅内动脉瘤的患者，其大脑前动脉动脉瘤破裂，同时伴有右侧大脑中动脉动脉瘤和右侧小床突旁动脉瘤。患者在一期手术中通过右侧眶上入路对所有动脉瘤进行了手术夹闭。在夹闭相关动脉瘤后，隐藏的床突旁动脉瘤需要进行前床突切除术以进行最终夹闭。在双极电凝后，用显微剪刀在前床突上方做一个小的硬脑膜切开。随后，使用电动高速金刚石钻（直径3毫米）在视觉控制下进行前床突切除术。根据术前对该病例的放射学分析确定的动脉瘤解剖结构和确切位置来确定钻孔的方向和大小。在完全显露动脉瘤后应用最终夹闭。术后计算机断层扫描血管造影显示无并发症。
前床突切除术是一种有用的手术方法，旨在对位置和形态具有挑战性的床突旁动脉瘤进行适当的最终夹闭。
http://surgicalneurologyint.com/videogallery/right-clinoidectomy/
