Lanzino G, diPierro C G, Laws E R
Department of Neurosurgery, University of Virginia, Charlottesville, USA.
Acta Neurochir (Wien). 1998;140(5):491-3. doi: 10.1007/s007010050130.
Major intracranial vessels can be damaged during tumor resection. With the availability of refined microvascular techniques, direct repair or by-pass of the damaged segment is possible. These methods, however, often require temporary occlusion of the offending vessel, can result in a less than optimal angiographic result, and are difficult to perform in a deep field. Additionally, in some patients direct repair or by-pass is not feasible because of the friability of the vessel or as a result of the large size of the tear. In these cases the Sundt clip-graft represents a valid adjunct to the armamentarium of the surgeon. Over the years, it has been used by the senior author in five patients where vascular injury occurred during the removal of brain tumors (3 meningiomas, one pituitary adenoma, and one low-grade glioma). In this report we illustrate our most recent experience with this ingenious tool. A 22-year-old man underwent resection of a recurrent left temporal lobe low-grade glioma. During resection of the tumor, a tear occurred in a branch of the middle cerebral artery. The tear was repaired using a Sundt clip-graft. A post-operative angiogram, performed five days later, showed patency of the vessel with no evidence of wall irregularities. Described 30 years age to be used primarily in aneurysm surgery, the Sundt clip-graft provides an excellent, too often forgotten, sutureless method of repairing intracranial vessels damaged during tumor removal.
在肿瘤切除过程中，主要的颅内血管可能会受损。随着精细微血管技术的出现，对受损节段进行直接修复或搭桥成为可能。然而，这些方法通常需要临时阻断相关血管，可能导致血管造影结果不尽人意，并且在深部区域操作困难。此外，在一些患者中，由于血管脆弱或撕裂口较大，直接修复或搭桥并不可行。在这些情况下，Sundt夹移植物是外科医生的有效辅助工具。多年来，资深作者已在5例脑肿瘤切除过程中发生血管损伤的患者中使用了该工具（3例脑膜瘤、1例垂体腺瘤和1例低级别胶质瘤）。在本报告中，我们阐述了使用这种巧妙工具的最新经验。一名22岁男性接受了复发性左颞叶低级别胶质瘤切除术。在肿瘤切除过程中，大脑中动脉的一个分支发生了撕裂。使用Sundt夹移植物对撕裂进行了修复。术后五天进行的血管造影显示血管通畅，没有血管壁不规则的迹象。Sundt夹移植物在30年前被描述为主要用于动脉瘤手术，它提供了一种出色的、常常被遗忘的、无需缝合的方法来修复肿瘤切除过程中受损的颅内血管。
