Blading Technique for Preservation of Perforating Arteries in Clipping Surgery of Unruptured Cerebral Aneurysms

Mizutani, Tohru; Sugiyama, Tatsuya; Wada, Akira; Sumi, Kazuya; Matsumoto, Masaki; Yabuzaki, Hajime; Hirose, Eisuke; Irie, Ryo; Kushamae, Mika; Kawauchi, Yuta

doi:10.2335/scs.42.397

Surg. Cereb. Stroke

2014

DOI: 10.2335/scs.42.397

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Blading Technique for Preservation of Perforating Arteries in Clipping Surgery of Unruptured Cerebral Aneurysms

Tohru Mizutani

Tatsuya Sugiyama

Akira Wada

et al.

Abstract: Summary:One of the most important factors for successful operation of unruptured aneurysms is preservation of perforating arteries. Various surgical approaches and methods including MEP and ICG monitoring have been reported. However, a basic safe technique of manipulating the clip blade has not been related.To preserve perforating arteries, it is important to keep the tip of the blade in the visual field until completion of clipping.

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2023

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内頚動脈瘤のクリッピング術における穿通枝虚血回避の対策と手術成績 ─術後急性期のmrによる評価─

KAWAMOTO,

IKEDA,

AKUTSU

et al. 2023

Surg. Cereb. Stroke

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Preservation of blood flow in perforating arteries is of paramount importance in aneurysm surgery to avoid devastating ischemic complications. Surgical strategies for internal carotid artery (ICA) aneurysms include: 1) detailed evaluation of the anatomy of the perforators and aneurysms in preoperative imaging, especially assessing the cerebrospinal fluid space around the perforator, parent artery, and aneurysm using construction interference in steady state (CISS) images, 2) performing a sufficiently wide craniotomy and creating a wide opening of the sylvian fissure to allow for multiple viewing angles, 3) thoroughly inspecting perforators under direct vision, with the aid of an endoscope when necessary, 4) meticulously dissecting perforators as freely as possible while avoiding injury to the aneurysmal wall, 5) placing clips with the utmost care, using a combination of clips when necessary to occlude the origin of the perforator, 6) confirming blood flow using indocyanine green (ICG) videoangiography and assessing the function of the corticospinal tract through motor-evoked potential (MEP) monitoring at the end of the procedure. One hundred sixty-one patients underwent surgical clipping of 170 ICA aneurysms between 2012 and 2021. Target aneurysms were located at the posterior communicating artery (PCoA) in 101 patients, anterior choroidal artery (AChA) in 49, bifurcation of the internal carotid artery (ICB) in 15, and C1 segment of the ICA in 5. No intra-operative ruptures were observed. Temporary occlusion of the ICA was performed in 44 procedures (27.3%) with a mean duration of 169.9 seconds. A combination of clips was used to occlude the origin of the perforator in 14 patients with AChA aneurysms. Changes in MEP amplitude was observed in six (3.7%) procedures; the MEP fully recovered after readjustment of the clip(s) in the procedures. Postoperatively, all 161 patients left the hospital with a modified Rankin Scale score of 0. Diffusion-weighted imaging (DWI) on postoperative day 4 revealed high-intensity lesions (DWHI) in the area of the perforators adjacent to the aneurysm in 15 patients (9.3%), all of whom were asymptomatic. Aneurysms located at the ICB

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内頚動脈瘤のクリッピング術における穿通枝虚血回避の対策と手術成績 ─術後急性期のmrによる評価─

KAWAMOTO,

IKEDA,

AKUTSU

et al. 2023

Surg. Cereb. Stroke

View full text Add to dashboard Cite

show abstract

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Blading Technique for Preservation of Perforating Arteries in Clipping Surgery of Unruptured Cerebral Aneurysms

Cited by 1 publication

References 3 publications

内頚動脈瘤のクリッピング術における穿通枝虚血回避の対策と手術成績 ─術後急性期のmrによる評価─

内頚動脈瘤のクリッピング術における穿通枝虚血回避の対策と手術成績 ─術後急性期のmrによる評価─

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