Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
World Neurosurg. 2020 Jul;139:361-369. doi: 10.1016/j.wneu.2020.04.099. Epub 2020 Apr 24.
It can sometimes be challenging to find a suitable clip to treat an unusual aneurysm, or when the surrounding anatomy is unusual, especially in resource-limited environments. We describe a method to modify aneurysm clips based on the method originated by Sugita et al in 1985. Herein clip modification (Clip-Mod) is used to treat anatomically difficult anterior communicating artery aneurysms.
The Department of Neurological Surgery database was reviewed to find aneurysm patients treated using modified aneurysm clips. Clip-Mod was performed during surgery by shortening the tines of titanium aneurysm clips by abrasion applied from the side of a standard 3-mm surgical diamond drill bit under constant irrigation. Note that the thickness of the tines and the clip spring were not modified or contacted by the drill.
Four cases used modified aneurysm clips, from 648 total clip-treated aneurysms (0.6%) by 2 surgeons over a 14-year period. Three patients presented with subarachnoid hemorrhages that were determined to be due to anterior communicating artery aneurysms. One patient presented with an incidental unruptured anterior communicating artery aneurysm. All 4 patients were treated with 3-mm titanium clips shortened intraoperatively to 1- to 2-mm lengths, to achieve aneurysm obliteration without stenosing parent or perforating vessels.
All 4 patients have done well clinically with no reoccurrences after 2-6 years' follow-up, which included angiographic evaluation. The use of this "Clip-Mod" technique thus appears useful for anterior communicating artery aneurysms. Clip-Mod could also be considered for treating other aneurysms when the "perfect" length clip is not available.
在资源有限的环境中，有时很难找到合适的夹闭装置来治疗不常见的动脉瘤，或者当周围解剖结构不寻常时，尤其是在资源有限的环境中。我们描述了一种基于 Sugita 等人 1985 年首创的方法来修改动脉瘤夹的方法。在此，夹闭装置修改（Clip-Mod）用于治疗解剖困难的前交通动脉动脉瘤。
神经外科数据库进行了回顾，以找到使用改良动脉瘤夹治疗的动脉瘤患者。Clip-Mod 在手术中通过从标准 3mm 手术金刚石钻头的一侧施加磨损来缩短钛合金动脉瘤夹的叉齿来完成，同时保持持续冲洗。请注意，钻头没有修改或接触叉齿和夹闭装置的弹簧的厚度。
4 例患者使用了改良的动脉瘤夹，这是在 14 年间由 2 位外科医生用 648 个夹闭装置治疗的动脉瘤（0.6%）中的 4 例。3 例患者出现蛛网膜下腔出血，被认为是前交通动脉动脉瘤引起的。1 例患者出现未破裂的前交通动脉动脉瘤。所有 4 例患者均采用 3mm 钛夹，术中缩短至 1-2mm 长度，以实现动脉瘤闭塞，同时不狭窄母血管或穿支血管。
所有 4 例患者在 2-6 年的随访中均有良好的临床结果，包括血管造影评估，均未复发。因此，这种“Clip-Mod”技术对于前交通动脉动脉瘤似乎是有用的。当没有“完美”长度的夹闭装置时，Clip-Mod 也可以考虑用于治疗其他动脉瘤。
