Pelissou-Guyotat I, Mottolese C, Deruty R
Service de Neurochirurgie D, Hôpital Neurologique, Lyon.
Neurochirurgie. 1993;39(3):166-70.
Wrapping is a well-known alternative technique when clipping the aneurysm is by no means possible or when it seems necessary to complete an imperfect clip. In 22 operated cases of intracranial aneurysm, we recently experienced pledgets of Teflon arranged and then fixed by drops of fibrin sealant. We used this technique in the following operative circumstances: to reinforce the ectatic base of the clipped aneurysm (11 cases); to wrap a pre-aneurysmal ectasia distant from the ruptured aneurysm (5 cases); to minimize the compression due to the clip to an adjacent cranial nerve or artery (6 cases). So far no complication was noted in relation to this technique. We then propose this technique of wrapping or interposing Teflon as an alternative to the other well-known techniques using autogenous tissue, gelatin sponge, cotton or other synthetic coatings or glue. Up to now, no known material received a worldwide approval for its complete innocuity and/or efficiency. Nowadays, in neurosurgical microvascular decompression and in cardiovascular surgery Teflon is widely and satisfactorily used. Its biologic tolerance is known to be good. This may apply in this new indication, and we would like recommend its practical use. However, for reliability and safety, there is an obvious need for a long-term clinical follow-up and an experimental controlled study as well.
当夹闭动脉瘤完全不可能或似乎有必要完善不完美的夹闭时，包裹是一种众所周知的替代技术。在最近22例颅内动脉瘤手术病例中，我们使用了经纤维蛋白密封剂滴液排列并固定的特氟龙棉片。我们在以下手术情况下使用了该技术：加固夹闭动脉瘤的扩张基底（11例）；包裹远离破裂动脉瘤的动脉瘤前扩张（5例）；尽量减少夹子对相邻颅神经或动脉的压迫（6例）。到目前为止，尚未发现与该技术相关的并发症。然后，我们提出这种包裹或置入特氟龙的技术，作为使用自体组织、明胶海绵、棉花或其他合成涂层或胶水的其他知名技术的替代方法。到目前为止，还没有一种已知材料因其完全无害和/或有效性而获得全球认可。如今，在神经外科微血管减压和心血管手术中，特氟龙被广泛且令人满意地使用。已知其生物耐受性良好。这可能适用于这一新的适应症，我们建议实际应用。然而，为了可靠性和安全性，显然也需要进行长期临床随访和实验对照研究。
