Tanaka Riki, Ansari Ahmed, Kato Yoko, Yamada Yasuhiro, Kawase T, Kalyan Sai
Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
Asian J Neurosurg. 2019 Jul-Sep;14(3):863-867. doi: 10.4103/ajns.AJNS_133_17.
A subgroup of complex aneurysms demands multimodal treatment by microscopic and endovascular means. Partial obliteration or remnant postprocedure demands to go further to the other modality.
All patients between July 2016 and January 2017 who had to undergo multimodality measures for complete obliteration of the aneurysms were included in the study. The patients who had either undergone clipping or coiling for their aneurysms, but with incomplete obliteration of the aneurysm, were also included in the study.
Between July 2016 and January 2017, a total of three patients had to undergo coiling after clipping of the aneurysm for complete obliteration. Two patients had to go for clipping following coiling. All five patients had complete obliteration of the aneurysm sac.
Both microscopic and endovascular means are complementary measures instead of competing procedures. It is important to realize the technical difficulties when surgical therapy follows initial endovascular treatment. Similarly, coiling a previously clipped aneurysm can be difficult, if the clip obscures normal working projections.
一部分复杂动脉瘤需要通过显微手术和血管内介入手段进行多模态治疗。部分闭塞或术后残余需要进一步采用另一种治疗方式。
本研究纳入了2016年7月至2017年1月期间所有因完全闭塞动脉瘤而必须接受多模态治疗的患者。那些因动脉瘤已接受夹闭或栓塞治疗，但动脉瘤未完全闭塞的患者也被纳入本研究。
2016年7月至2017年1月期间，共有3例患者在动脉瘤夹闭术后需进行栓塞以实现完全闭塞。2例患者在栓塞术后需进行夹闭。所有5例患者的动脉瘤囊均实现了完全闭塞。
显微手术和血管内介入手段是互补措施而非相互竞争的手术方式。重要的是要认识到在初始血管内治疗后进行手术治疗时的技术困难。同样，如果夹子遮挡了正常的工作视野，对先前已夹闭的动脉瘤进行栓塞可能会很困难。
