Akamatsu Yosuke, Kashimura Hiroshi, Suzuki Taro, Aso Kenta, Oshida Sotaro
Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
World Neurosurg. 2019 Feb;122:240-244. doi: 10.1016/j.wneu.2018.10.222. Epub 2018 Nov 9.
Fenestrated miniclips were developed as an effective tool for dog-ear-shaped remnants of aneurysms. However, the special property of these clips may have other applications. Here, we report 2 cases of ruptured small aneurysm and suggest the alternative utility of a single application of a fenestrated miniclip.
A 77-year-old woman was admitted to our hospital with subarachnoid hemorrhage due to an anterior communicating aneurysm. The aneurysm was treated with surgical clipping via a right pterional approach. Because dissection of tight adhesion between the aneurysm and ipsilateral A2 might cause intraoperative bleeding, the angled fenestrated miniclip was applied across the ipsilateral A2 without dissection of adhesion and obliterated the aneurysm without complications. In another case, a 60-year-old man presented with subarachnoid hemorrhage due to ruptured vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm and was treated with surgical clipping via a far-lateral approach. Because aneurysm visualization was impeded by PICA even after mobilization of the PICA and vertebral artery, a fenestrated standard-clip was applied across the PICA. However, this clip impeded visualization of the aneurysm and could not be opened in the tight surgical field. In contrast, subsequent application of a fenestrated miniclip allowed better visualization of the aneurysm, even in a tight field, and resulted in successful obliteration of the aneurysm.
Single application of fenestrated mini-clips may be suitable in cases of small aneurysms with thin walls adhering to branch vessels or where visualization of the aneurysm is impeded by the parent artery.
开窗微型夹被开发为一种用于处理动脉瘤狗耳状残端的有效工具。然而，这些夹子的特殊特性可能还有其他应用。在此，我们报告2例破裂小动脉瘤病例，并提出开窗微型夹单次应用的其他效用。
一名77岁女性因前交通动脉瘤破裂导致蛛网膜下腔出血入住我院。通过右侧翼点入路对动脉瘤进行手术夹闭治疗。由于动脉瘤与同侧A2之间紧密粘连的分离可能导致术中出血，因此在未分离粘连的情况下，将成角开窗微型夹跨过同侧A2应用，成功闭塞动脉瘤且无并发症。在另一例中，一名60岁男性因椎动脉 - 小脑后下动脉（PICA）动脉瘤破裂导致蛛网膜下腔出血，通过远外侧入路进行手术夹闭治疗。即使在游离PICA和椎动脉后，PICA仍妨碍动脉瘤的显露，因此将标准开窗夹跨过PICA应用，但该夹子妨碍了动脉瘤的显露，且在狭小的手术视野中无法打开。相比之下，随后应用开窗微型夹即使在狭小视野中也能更好地显露动脉瘤，并成功闭塞动脉瘤。
开窗微型夹单次应用可能适用于薄壁小动脉瘤附着于分支血管或动脉瘤显露受载瘤动脉妨碍的情况。
