He Haiyong, Chen Chuan, Li Wensheng, Luo Lun, Ling Cong, Wang Hui, Chen Zhuopeng, Guo Ying
Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China.
Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):1099-1106. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.040. Epub 2019 Jan 17.
Our objective was to review 15 consecutive patients with anterior circulation aneurysms managed through a contralateral approach. Individualized surgical simulation using three-dimensional (3D) imaging was adopted to enable safe performance of clipping surgery.
Five patients had multiple intracranial aneurysms, and 10 patients had a single aneurysm on the contralateral side of the craniotomy. Preoperatively, the unique architecture of aneurysms was fully understood in their 3-dimensionality reconstructed by Mimics software. The location of the cranial bone window and the patient's head position was individually optimized using a preoperative simulation system.
In this cohort, 17 contralateral aneurysms showed no wall calcifications. Projections of the aneurysms were superomedial (3/17, 17.6%), medial (8/17, 47.1%), posterior (3/17, 17.6%), and superior (3/17, 17.6%). The visual similarity between the simulating scene and the operative view was excellent in 100% of the cases. Four patients were treated with a contralateral pterional approach, and the remaining 11 patients were treated with a contralateral supraorbital keyhole approach. All of them were well-clipped, except 1 blister-like aneurysm being wrapped. All 15 patients had good outcomes (mRS ≤ 3) after a mean 13 months follow-up. There were no recurrences after surgical treatment.
The contralateral approach for the selected anterior circulation aneurysms is feasible in experienced hands with acceptable morbidity. This approach should be the choice only under judicious case-to-case planning based on a preoperative 3D virtual osteotomy technique.
我们的目的是回顾连续15例通过对侧入路治疗的前循环动脉瘤患者。采用三维（3D）成像进行个体化手术模拟，以确保夹闭手术的安全进行。
5例患者有多发性颅内动脉瘤，10例患者在开颅手术对侧有单个动脉瘤。术前，通过Mimics软件重建的三维模型充分了解动脉瘤的独特结构。使用术前模拟系统对颅骨骨窗位置和患者头部位置进行个体化优化。
在该队列中，17个对侧动脉瘤无壁钙化。动脉瘤的投影方向为上内侧（3/17，17.6%）、内侧（8/17，47.1%）、后方（3/17，17.6%）和上方（3/17，17.6%）。模拟场景与手术视野的视觉相似度在所有病例中均为极佳。4例患者采用对侧翼点入路，其余11例患者采用对侧眶上锁孔入路。除1例水泡样动脉瘤采用包裹治疗外，其余均成功夹闭。15例患者均获得良好预后（改良Rankin量表评分≤3分），平均随访13个月。手术治疗后无复发。
对于选定的前循环动脉瘤，对侧入路在经验丰富的医生手中是可行的，且发病率可接受。这种入路仅应在基于术前3D虚拟截骨技术进行审慎的个案规划下选择。
