Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
World Neurosurg. 2019 Jul;127:405-408. doi: 10.1016/j.wneu.2019.02.179. Epub 2019 Mar 9.
Fenestrated mini-clips have been reported as useful for treating dog ear-shaped remnant aneurysms, the small aneurysms to which the efferent artery adheres or is impeded by the surrounding neurovascular structure in the restricted operative corridor, because of the smaller clip head. Here, the alternative utility of fenestrated mini-clip was reported by mentioning the narrower clip blade.
We report a case of middle cerebral artery aneurysm tightly adhered by the anterior temporal artery (ATA) as well as the efferent arteries and demonstrate the utility of fenestrated mini-clip.
During aneurysm dissection, the superior division of the M2 segment of the middle cerebral artery and the ATA adhered tightly to the aneurysm, thereby restricting meticulous aneurysm dissection. To preserve the efferent artery and the ATA, a fenestrated standard clip was applied, transmitting the efferent artery, and the clip blade was applied in the restricted space between the adhering ATA and the aneurysm neck. However, because kinking of the ATA was observed following first clip application, the fenestrated mini-clip was applied in similar fashion to avoid kinking of the ATA instead of a standard clip, thereby preserving the ATA without further aneurysm dissection. Finally, successful obliteration of the aneurysm and preservation of the ATA were achieved with the subsequent clip application.
In selected cases, application of a narrower bladed fenestrated mini-clip in the restricted space may be useful to preserve tightly adhering branch arteries, as well as efferent arteries.
由于夹头较小，分叶型迷你夹已被报道可用于治疗犬耳状残瘤动脉瘤，即流出动脉紧贴或被受限手术通道内的周围神经血管结构阻碍的小动脉瘤。在此，通过提及更窄的夹片来报告分叶型迷你夹的另一种用途。
我们报告了一例大脑中动脉动脉瘤紧密附着在前颞动脉（ATA）以及流出动脉的病例，并展示了分叶型迷你夹的用途。
在进行动脉瘤解剖时，大脑中动脉 M2 段的上部分和 ATA 与动脉瘤紧密附着，从而限制了对动脉瘤的精细解剖。为了保护流出动脉和 ATA，应用了分叶标准夹，使流出动脉通过，并将夹片应用于附着的 ATA 和动脉瘤颈部之间的受限空间。然而，由于第一次夹闭后观察到 ATA 的扭曲，因此以类似的方式应用分叶型迷你夹以避免 ATA 的扭曲，从而在不进一步解剖动脉瘤的情况下保留 ATA。最后，通过随后的夹闭应用成功地闭塞了动脉瘤并保留了 ATA。
在选择的病例中，在受限空间中应用更窄的叶片分叶型迷你夹可能有助于保留紧密附着的分支动脉以及流出动脉。
