Huang Wei, Zhang Mingsheng, Wang Wenhao, Luo Fei, Li Jun, Zhang Yuan, Lin Junming, Zou Xiaojun, Cai Genping
Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China.
Department of Neurosurgery, The 909th Hospital, School of Medicine, Xiamen University, China.
Clin Neurol Neurosurg. 2023 Oct;233:107905. doi: 10.1016/j.clineuro.2023.107905. Epub 2023 Jul 20.
Surgical clipping of pericallosal artery aneurysm is technically challenging since it is fragile and tends to rupture accidentally during the operation. This study was aimed to evaluate the efficacy and safety of MRI-neuronavigation-assisted microsurgery for pericallosal artery aneurysm clipping. Forty patients diagnosed with pericallosal artery aneurysms who underwent craniotomy clipping were enrolled. Among these patients, 18 cases accepted routine surgical approaches, while another 22 cases accepted MRI-neuronavigation-assisted microsurgery. Design of craniotomy, operation pathway, operation duration, intraoperative cerebral protection and superior drainage vein protection were analyzed retrospectively. All the 40 cases underwent aneurysm clipping by pre-coronal inter-hemispheric approach, and all aneurysms were clipped completely confirmed by postoperative CTA or DSA. During the operations, MRI-neuronavigation provided precise spatial configuration of pericallosal artery aneurysms, and allowed accurate and real-time identification for the adjacent arteries and brain structures, and no aneurysms ruptured accidentally during the operations. Functional cortex and draining veins were protected well. Compared with routine surgical approaches, the MRI-neuronavigation-assisted microsurgery showed less operation duration, few adverse events induced by accurate location for aneurysm and less invasion to draining veins. Therefore, MRI-neuronavigation-assisted microsurgery could precisely locate the pericallosal artery aneurysm, optimize surgical approaches, and help to cerebral protection. It is expected to reduce the surgical risk and improve the precision and security, can be regarded as an effective technology in the clipping of pericallosal artery aneurysms.
胼周动脉动脉瘤的手术夹闭在技术上具有挑战性，因为该动脉瘤很脆弱，在手术过程中容易意外破裂。本研究旨在评估MRI神经导航辅助显微手术用于胼周动脉动脉瘤夹闭的有效性和安全性。纳入40例诊断为胼周动脉动脉瘤并接受开颅夹闭手术的患者。其中，18例采用常规手术入路，另外22例采用MRI神经导航辅助显微手术。回顾性分析开颅设计、手术路径、手术时长、术中脑保护及优势引流静脉保护情况。40例均采用冠状缝前经半球间入路进行动脉瘤夹闭，术后CTA或DSA证实所有动脉瘤均夹闭完全。手术过程中，MRI神经导航提供了胼周动脉动脉瘤精确的空间构型，能够准确实时识别相邻动脉和脑结构，术中无动脉瘤意外破裂。功能皮质和引流静脉得到良好保护。与常规手术入路相比，MRI神经导航辅助显微手术手术时长较短，动脉瘤准确定位导致的不良事件较少，对引流静脉的侵袭也较少。因此，MRI神经导航辅助显微手术能够精确地定位胼周动脉动脉瘤，优化手术入路，有助于脑保护。有望降低手术风险，提高手术的精确性和安全性，可被视为胼周动脉动脉瘤夹闭术中的一种有效技术。
