Katsuki Masahito, Wada Naomichi, Yamamoto Yasunaga
Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan.
Surg Neurol Int. 2020 Apr 25;11:76. doi: 10.25259/SNI_73_2020. eCollection 2020.
Subarachnoid hemorrhage with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We could not identify the ruptured aneurysm preoperatively, so we decided to treat all of the aneurysms as a single-stage surgery.
A 79-year-old woman was diagnosed with subarachnoid hemorrhage with multiple cerebral aneurysms at the right distal anterior cerebral artery, left middle cerebral artery, and right internal carotid artery- posterior communicating artery bifurcation. We could not identify the ruptured aneurysm preoperatively. We fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo) and performed clipping for each aneurysm with bifrontal craniotomy and bilateral frontotemporal craniotomy as a single-stage operation. The last aneurysm seemed ruptured, and clipping for all the aneurysms was successful. She was discharged with a good postoperative course. The Sugita head holding system allowed turning the head of the patient toward the right and left with single fixation, leading to this single-stage operation.
Several methods for identifying a ruptured aneurysm from multiple aneurysms have been reported, but under limited medical resources, this procedure would be one of the treatment strategies.
伴有多个动脉瘤的蛛网膜下腔出血极具挑战性，因为很难确定破裂的动脉瘤。我们术前无法确定破裂的动脉瘤，所以决定将所有动脉瘤作为一期手术进行治疗。
一名79岁女性被诊断为患有多个脑动脉瘤导致的蛛网膜下腔出血，这些动脉瘤位于右侧大脑前动脉远端、左侧大脑中动脉以及右侧颈内动脉-后交通动脉分叉处。我们术前无法确定破裂的动脉瘤。我们使用杉田头部固定系统（东京瑞穗株式会社）固定她的头部，并通过双额开颅术和双侧额颞开颅术作为一期手术对每个动脉瘤进行夹闭。最后一个动脉瘤似乎是破裂的，所有动脉瘤的夹闭均成功。她术后恢复良好并出院。杉田头部固定系统可通过单次固定使患者头部左右转动，从而实现了这一期手术。
已经报道了几种从多个动脉瘤中识别破裂动脉瘤的方法，但在医疗资源有限的情况下，这种手术方法将是治疗策略之一。
