Tsunoda Sho, Inoue Tomohiro, Takeuchi Naoko, Akabane Atsuya, Saito Nobuhito
Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan.
Department of Rehabilitation, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan.
J Neurol Surg B Skull Base. 2021 Jun 3;83(5):505-514. doi: 10.1055/s-0041-1730351. eCollection 2022 Oct.
Because of their anatomical features, treatment for paraclinoid aneurysms has remained to be challenging. Thus, the aim of this report is to prove the validity of our surgical method for unruptured paraclinoid aneurysms, together with surgical videos. Between August 2017 and November 2019, we were able to perform surgical clipping for 11 patients with unruptured paraclinoid aneurysm using a completely unified method. This study investigated the effect of surgery on multiple measures, including visual impairment, brain contusion, temporalis muscle atrophy, and multiple neurocognitive functions. Of the 67 unruptured aneurysms treated at our hospital, 17 were identified to be paraclinoid aneurysm, and 11 of them were treated by direct clipping using anterior clinoidectomy. Three were ophthalmic artery aneurysms, three were superior hypophyseal artery aneurysms, and five were anterior carotid wall aneurysms without branch projection. Only one patient had asymptomatic mild enlargement of the Marriott blind spots postoperatively. No brain contusion and temporalis muscle atrophy were observed in any cases. Only the Trail Making test (TMT) showed a significant worsening in the acute postoperative period: mean pre- and postoperative TMT scores were 59.1 ± 29.1 and 72.7 ± 37.3 for Part A ( = 0.018) and 80.5 ± 35.5 and 93.8 ± 39.9 for Part B ( = 0.030), respectively. However, it improved in the chronic phase. We can conclude that our surgical method is safe and can be considered an acceptable treatment. Although surgical stress can cause temporary executive dysfunction shortly after surgery, this decline is temporary.
由于其解剖学特征，床突旁动脉瘤的治疗一直具有挑战性。因此，本报告的目的是通过手术视频证明我们针对未破裂床突旁动脉瘤的手术方法的有效性。2017年8月至2019年11月期间，我们能够使用完全统一的方法对11例未破裂床突旁动脉瘤患者进行手术夹闭。本研究调查了手术对多种指标的影响，包括视力损害、脑挫伤、颞肌萎缩和多种神经认知功能。在我院治疗的67例未破裂动脉瘤中，17例被确定为床突旁动脉瘤，其中11例通过前床突切除术直接夹闭治疗。3例为眼动脉动脉瘤，3例为垂体上动脉动脉瘤，5例为无分支突出的颈总动脉前壁动脉瘤。术后仅1例患者出现无症状性轻度马氏盲点扩大。所有病例均未观察到脑挫伤和颞肌萎缩。仅连线测验（TMT）在术后急性期有显著恶化：A部分术前和术后的平均TMT评分分别为59.1±29.1和72.7±37.3（P = 0.018），B部分分别为80.5±35.5和93.8±39.9（P = 0.030）。然而，在慢性期有所改善。我们可以得出结论，我们的手术方法是安全的，可以被认为是一种可接受的治疗方法。虽然手术应激可能在术后短期内导致暂时的执行功能障碍，但这种下降是暂时的。
