医学
剪裁(形态学)
动脉瘤
外科
放射科
颈内动脉
显微外科
改良兰金量表
血管造影
剪辑
后交通动脉
内科学
缺血
缺血性中风
语言学
哲学
作者
Tomoya Kamide,Jan‐Karl Burkhardt,Halima Tabani,Michael Safaee,Michael T. Lawton
出处
期刊:Operative Neurosurgery
[Oxford University Press]
日期:2019-09-12
卷期号:18 (2): 183-192
被引量:20
摘要
Abstract BACKGROUND Microsurgical clipping of paraclinoid aneurysms presents unique technical challenges because of the anatomical complexity of the paraclinoid region. OBJECTIVE To analyze microsurgical clipping techniques, complications, and outcomes associated with paraclinoid aneurysms, with a focus on clip selection and clipping technique according to aneurysm location. METHODS From 1997 to 2016, 231 unruptured paraclinoid aneurysms from 216 patients were treated using microsurgical clipping. We retrospectively reviewed patient records to analyze clinical outcomes. RESULTS A total of 80 aneurysms (34.6%) were treated with simple clipping. Among them, fenestrated clips were used with superior hypophyseal artery (SHA) aneurysms, but curved clips were used with most other aneurysms. A total of 151 aneurysms (65.6%) were treated using multiple clips, including tandem clipping for ophthalmic artery (OphA) aneurysms, tandem angled-fenestrated clipping for SHA and ventral carotid aneurysms, stacked clipping for dorsal carotid aneurysms, and various techniques for clinoidal segment/carotid cave aneurysms. Postoperative angiography was performed in 214 aneurysms (92.6%), and complete obliteration was confirmed in 195 aneurysms (91.1%). Using the modified Rankin Scale (mRS), overall functional outcome was good (mRS 0-2) in 99.6% of patients, although 30 cases (13.0%) showed new postoperative visual deficits. CONCLUSION Surgical clipping of paraclinoid aneurysms is an excellent treatment modality with good clinical outcomes and acceptable complication rates, particularly in centers with large experience in the microsurgical management of cerebrovascular disorders. Appropriate clip selection and clipping techniques are required to perform complete and safe clipping.
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