Clipping of paraclinoid carotid aneurysm <italic style="font-style: italic">via</italic> combined head and neck approach with assistance of multiple intraoperative monitoring: report of 35 cases

Xintong WU; Zhaohui HE

doi:10.16016/j.1000-5404.202008134

您当前的位置：

首页 >

文章列表页 >

Clipping of paraclinoid carotid aneurysm via combined head and neck approach with assistance of multiple intraoperative monitoring: report of 35 cases

Neurosciences | 更新时间：2026-01-09

- Clipping of paraclinoid carotid aneurysm via combined head and neck approach with assistance of multiple intraoperative monitoring: report of 35 cases
- Journal of Third Military Medical University Vol. 43, Issue 2, Pages: 131-136(2021)
- 作者机构：
  
  400016 重庆, 重庆医科大学附属第一医院神经外科
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81870927);the General Program of Natural Science Foundation of Chongqing(CSTC2019jcyj-msxmX0239)
- DOI：10.16016/j.1000-5404.202008134
  CLC： R181.32;R741.05;R743.9
- Received：17 August 2020，
  
  Revised：2020-09-13，
  
  Published：30 January 2021
- 稿件说明：
移动端阅览
Xintong WU, Zhaohui HE. Clipping of paraclinoid carotid aneurysm via combined head and neck approach with assistance of multiple intraoperative monitoring: report of 35 cases[J]. Journal of Third Military Medical University, 2021, 43(2): 131-136.
DOI：

Xintong WU, Zhaohui HE. Clipping of paraclinoid carotid aneurysm via combined head and neck approach with assistance of multiple intraoperative monitoring: report of 35 cases[J]. Journal of Third Military Medical University, 2021, 43(2): 131-136. DOI： 10.16016/j.1000-5404.202008134.

摘要

目的

探讨多种术中监测辅助下头颈部联合入路床突旁动脉瘤夹闭术的手术效果。

方法

回顾性分析重庆医科大学附属第一医院神经外科2016年1月至2019年12月在体感诱发电位(somatosensory evoked potential

SEP)、运动诱发电位(motor evoked potential

MEP)、多导皮层脑电图(multilobar electrocorticography

mEcoG)、多普勒血管超声、吲哚氰绿造影技术术中辅助下行头颈部联合入路床突旁动脉瘤夹闭术患者的临床资料，术后均行CTA或DSA评估夹闭效果，出院时采用改良Rankin评分量表(modified Rankin Scale

mRS)评估患者近期预后，并对患者进行临床观察及影像学随访以评估远期预后。

结果

共35例患者，术中夹闭床突旁动脉瘤35个，术后经CTA或DSA证实仅1例存在瘤颈残留，余34例患者均夹闭完全。围手术期无死亡。出院时mRS评分结果，预后良好32例，约占91%，预后不良3例，约占9%。35例患者均获得随访，随访时间为6~18(12±4)个月，根据随访资料采用mRS评分，预后良好30例，占86%，预后不良5例，占14%。

结论

在多种术中监测手段的辅助下，经头颈部联合入路于显微镜下夹闭床突旁动脉瘤安全可行，能获得满意的临床疗效。

Abstract

Objective

To explore the surgical efficacy of clipping surgery for paraclinoid carotid aneurysm (PCA)

via

combined head and neck approach assisted by multiple intraoperative monitoring.

Methods

Clinical data of the PCA patients treated in our department from January 2016 to December 2019 were collected and analyzed retrospectively

who underwent clipping surgery in combined head and neck approach with the aid of monitoring of somatosensory evoked potential (SEP)

motor evoked potential (MEP) and multilobar and electrocorticography (mEcoG)

Doppler vascular ultrasound examination

and indole cyanogen green (ICG) imaging. Postoperative computed tomography angiography (CTA) or digital subtraction angiography (DSA) was performed to evaluate the clipping effect. The recent prognosis of the patients was evaluated at discharge with the modified Rankin Scale (mRS)

and the long-term prognosis was comprehensively assessed based on the follow-up neuroimaging data and clinical observation of the patients.

Results

The 35 patients (11 males and 24 females

a mean age of 52.3 years) had 35 clipped PCA. Postoperative CTA or DSA confirmed that only 1 patient had residual aneurysm neck

and the remaining 34 patients obtained perfect clipping efficacy

with no death during the perioperative period. According to mRS score at discharge

32 patients had a good prognosis (91%) and 3 patients had a poor one (9%). During the 6~18 months' follow-up (12±4 months on the average)

30 cases showed a good long-term prognosis (86%)

while the other 5 patients had poor prognosis (14%).

Conclusion

With the assistance of multiple intraoperative monitoring

it is safe and feasible to implement clipping surgery for PCA under the microscope

via

combined head and neck approach

and satisfactory clinical efficacy can be obtained.

关键词

Keywords

references

MORGAN M K, EFTKHAR B. Commentary: paraclinoid carotid aneurysms[J]. J Clin Neurosci, 2011, 18(1):23. DOI:10.1016/j.jocn.2010.07.123.

BARAMI K, HERNANDEZ V, DIAZ F, et al .Paraclinoid carotid aneurysms: surgical management, complications, and outcome based on a new classification scheme[J ] . Skull Base, 2004, 13(1): 31-42. DOI: 10.1055/s-2003-37551.

D'URSO P I, KARADELI H H, KALLMES D F, et al . Coiling for paraclinoid aneurysms: time to make way for flow diverters?[J ] . AJNR Am J Neuroradiol, 2012, 33(8): 1470-1474. DOI: 10.3174/ajnr.a3009.

HAN J S, KIM T H, OH J S, et al . Delayed monocular blindness after coil embolization of large paraclinoid aneurysm[J ] . J Cerebrovasc Endovasc Neurosurg, 2018, 20(4): 241-247. DOI: 10.7461/jcen.2018.20.4.241.

BERETTA F, ANDALUZ N, ZUCCARELLO M. Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: treatment options and strategies based on a clinicalseries[J]. J Neurosurg Sci, 2004, 48(4): 149-156.

BROWN M A, PARISH J, GUANDIQUE C F, et al . A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation[J ] . J Neurosurg, 2017, 126(3): 819-824. DOI: 10.3171/2016.2.jns152059.

IIHARA K, MURAO K, SAKAI N, et al .Unruptured paraclinoid aneurysms: a management strategy[J ] . J Neurosurg, 2003, 99(2): 241-247. DOI: 10.3171/jns.2003.99.2.0241.

段鸿洲, 李良, 张扬, 等.床突旁动脉瘤的外科治疗[J].北京大学学报(医学版), 2015, 47(4): 679-684.

DUAN H Z, LI L, ZHANG Y, et al . Surgical treatment of paraclinoid aneurysms[J ] . J Peking Univ Heal Sci, 2015, 47(4): 679-684.

SUZUKI K, WANIBUCHI M, MINAMIDA Y, et al . Heat generation by ultrasonic bone curette comparing with high-speed drill[J ] . Acta Neurochir (Wien), 2018, 160(4): 721-725. DOI: 10.1007/s00701-017-3445-0.

CHANG D J. The "No-drill" technique of anterior clinoidectomy: a cranial base approach to the paraclinoid and parasellar region[J]. Oper Neurosurg, 2009, 64(suppl_1): ONS96-ONS106. DOI: 10.1227/01.neu.0000335172.68267.01.

DEBATISSE D, PRALONG E, DEHDASHTI A, et al . Simultaneous multilobar electrocorticography (mEcoG) and scalp electroencephalography (scalp EEG) during intracranial vascular surgery: a new approach in neuromonitoring[J ] . Clin Neurophysiol, 2005, 116(12): 2734-2740. DOI: 10.1016/j.clinph.2005.08.011.

KUTTY R K, KUMAR A, YAMADA Y, et al . Visual outcomes after surgery for paraclinoid aneurysms: a fujita experience[J ] . Asian J Neurosurg, 2020, 15(2): 363-369. DOI: 10.4103/ajns.ajns_39_20.

KAMIDE T, TABANI H, SAFAEE M M, et al . Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms[J ] . J Neurosurg, 2018, 129(6): 1511-1521. DOI: 10.3171/2017.7.jns17673.

TAKAMURA Y, MOTOYAMA Y, TAKATANI T, et al . Motor evoked potential monitoring can evaluate ischemic tolerance to carotid artery occlusion during surgery[J ] . J Clin Monit Comput, 2020. DOI: 10.1007/s10877-020-00573-0.

何朝晖, 郭宗铎, 张晓东, 等.床突旁动脉瘤的显微手术治疗(附20例报告)[J].中华神经外科杂志, 2018, 34(5): 455-458. DOI: 10.3760/cma.j.issn.1001-2346.2018.05.006.

HE Z H, GUO Z D, ZHANG X D, et al . Microsurgical treatment of bedside aneurysms (a report of 20 cases)[J ] . Chin J Neurosurg, 2018, 34(5): 455-458. DOI: 10.3760/cma.j.issn.1001-2346.2018.05.006.

王振宇.术中神经电生理监测在微创神经外科的应用[J].中国微创外科杂志, 2010, 10(1): 13-15.

WANG Z Y. Application of intraoperative neuroelectrophysiological monitoring in minimally invasive neurosurgery[J]. Chin J Minim Invasive Surg, 2010, 10(1): 13-15.

ROESSLER K, KRAWAGNA M, DÖRFLER A, et al . Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature[J ] . Neurosurg Focus, 2014, 36(2): E7. DOI: 10.3171/2013.11.focus13475.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

No data

Related Author

No data

Related Institution

No data

⁰

Clipping of paraclinoid carotid aneurysm via combined head and neck approach with assistance of multiple intraoperative monitoring: report of 35 cases

DOI：10.16016/j.1000-5404.202008134

摘要

Abstract

关键词

Keywords

references