Effgen Erica Antunes, Teyssandier Mariano, Jiménez Luis Ángel Canache, da Trindade Érico Samuel Gomes Galvão, Céspedes Álvaro Rodrigo Quiñones, Guilherme Felipe Oliveira, Wuo-Silva Raphael, Chaddad-Neto Feres
Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 6th floor, São Paulo, 04024-001, SP, Brazil.
Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
Neurosurg Rev. 2025 May 26;48(1):444. doi: 10.1007/s10143-025-03605-y.
Temporary clipping consists of a well-defined technique applied during the surgical treatment of cerebral aneurysms. However, little has been described regarding the use of transient clipping during the surgical treatment of arteriovenous malformations (AVMs). In this study, we aim to describe the use of temporary clipping and how it may aid the surgical resection of AVMs, as well as to report a case series to exemplify its application.
A case series of 28 patients submitted to microsurgical resection of AVM in which a temporary clip was applied was described and 4 illustrative surgical cases were reported.
In most of the cases, the temporary clip was applied in the arterial feeders, during nidus dissection, under neurophysiological monitoring and observing the indocyanine green angiography (ICGA) study intraoperatively, and it facilitated the coagulation and reduced the occurrence of bleeding from these vessels, besides reducing the turgidity of the nidus and draining vein during its dissection; in addition, it may aid the identification of residual nidus. In the cases which the transient clip was applied in the draining veins, it usually was applied to reduce the caliber of the vein and facilitate its coagulation, to verify, with the aid of ICGA, if the AVM was completely dearterialized, and in cases with venous drainage to multiple sites for the ICGA study of the main draining vein. The percentage of postoperative complications was low.
The use of temporary clipping, combined with intraoperative ICGA and neurophysiological monitoring, consists of a useful tool during the steps of the AVM microsurgical resection, from the coagulation of arterial feeders and nidus dissection to studying the flow pattern and aiding the decision when to remove the venous outflow.
临时夹闭是一种在脑动脉瘤手术治疗中应用的明确技术。然而，关于动静脉畸形（AVM）手术治疗中短暂夹闭的应用描述较少。在本研究中，我们旨在描述临时夹闭的应用及其如何辅助AVM的手术切除，并报告一系列病例以举例说明其应用。
描述了一组28例行AVM显微手术切除并应用临时夹闭的病例系列，并报告了4例具有代表性的手术病例。
在大多数病例中，临时夹闭应用于动脉供血支，在病灶分离过程中，在神经生理监测下并术中观察吲哚菁绿血管造影（ICGA），它有助于血管凝固并减少这些血管出血的发生，此外还能在病灶分离时降低病灶和引流静脉的张力；此外，它有助于识别残留病灶。在将临时夹闭应用于引流静脉的病例中，通常是为了减小静脉管径并便于其凝固，借助ICGA验证AVM是否完全去动脉化，以及在静脉引流至多个部位的情况下用于对主要引流静脉进行ICGA研究。术后并发症发生率较低。
临时夹闭与术中ICGA和神经生理监测相结合，是AVM显微手术切除过程中从动脉供血支凝固、病灶分离到研究血流模式以及辅助决定何时去除静脉流出道等步骤中的一种有用工具。
