Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
World Neurosurg. 2023 Jun;174:127. doi: 10.1016/j.wneu.2023.03.052. Epub 2023 Mar 17.
Direct aneurysmal suction decompression was first described by Dr. Flamm in 1981 to improve safety and ease clipping of complex aneurysms by deflating their dome. This technique evolved over the following decade, from direct aneurysmal puncture to indirect-reverse-suction decompression (RSD). The conventional technique for RSD involves a cannulation of the internal (ICA) or common (CCA) carotid arteries. Direct puncture of either the CCA or ICA carry risk of arterial wall damage (e.g., dissection), which may result in significant morbidity. We routinely cannulate the superior thyroidal artery (SThA) as the vascular access to perform RSD. This subtle technical nuance prevents dissection of either the CCA or ICA while providing a reliable source for RSD. In this operative video, the SThA was cannulated to apply reverse suction decompression, which allowed releasing perforating arteries from the dome of an anterior choroidal artery aneurysm in a 68-year-old lady. The patient tolerated the procedure well, was discharged without neurologic deficits, and resumed normal life with no aneurysm remnant. The patient consented to the procedure and video/photography publication. RSD is an optimal technique to enhance efficiency and safety when dissecting around the dome of a complex intradural ICA aneurysm. The use of the SThA avoids the risk of ICA or CCA wall damage due to access, which defeats the protective purpose of RSD itself. Video 1 provides an educational example of the SThA cannulation technique for RSD during dissection and clipping of a complex anterior choroidal artery aneurysm.
直接动脉瘤抽吸减压术由 Flamm 医生于 1981 年首次描述，通过使瘤顶瘪陷来提高安全性和简化复杂动脉瘤夹闭术。这项技术在随后的十年中不断发展，从直接动脉瘤穿刺到间接-反向抽吸减压术（RSD）。RSD 的常规技术涉及颈内动脉（ICA）或颈总动脉（CCA）的血管内插管。直接穿刺 CCA 或 ICA 均有动脉壁损伤（例如夹层）的风险，可能导致严重的发病率。我们常规使用甲状腺上动脉（SThA）作为血管通路进行 RSD。这种微妙的技术细节可防止 CCA 或 ICA 的夹层，同时为 RSD 提供可靠的来源。在这个手术视频中，我们通过 SThA 进行插管以实施反向抽吸减压，从而使一位 68 岁女性前交通动脉动脉瘤瘤顶的穿通动脉解脱。患者对该过程耐受良好，出院时无神经功能缺损，恢复正常生活，无动脉瘤残留。患者同意进行该手术并同意视频/摄影发表。当在复杂的硬脊膜内 ICA 动脉瘤瘤顶周围进行解剖时，RSD 是一种提高效率和安全性的最佳技术。使用 SThA 可避免因进入血管而导致的 ICA 或 CCA 壁损伤的风险，这违背了 RSD 本身的保护目的。视频 1 提供了一个教育性的例子，展示了在解剖和夹闭复杂前交通动脉动脉瘤时，通过 SThA 进行 RSD 的插管技术。
