Protection of branches during clipping of low grade internal carotid communicating segment aneurysms via frontolateral keyhole approach
10.3760/cma.j.cn115354-20220507-00306
- VernacularTitle:额外侧锁孔入路低分级颈内动脉交通段动脉瘤夹闭术中分支动脉的保护
- Author:
Hongwei ZHANG
1
;
Dong ZHANG
;
Yan GU
;
Aimin LI
Author Information
1. 徐州医科大学附属连云港医院神经外科，连云港 222002
- Keywords:
Frontolateral keyhole approach;
Internal carotid communicating segment;
Branch artery;
Posterior communicating artery aneurysm;
Anterior choroidal artery
- From:
Chinese Journal of Neuromedicine
2022;21(8):795-800
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical experiences and outcomes of protection of branches during clipping of low grade internal carotid communicating segment (C7) aneurysms via frontolateral keyhole approach. Methods:Fifty-two patients with internal carotid C7 aneurysms and Hunt-Hess grading I-III, admitted to our hospital from January 2017 to December 2020, were chosen; 45 patients were with posterior communicating artery (PCoA) aneurysms, 6 patients were with anterior choroidal artery (ACHA) aneurysms, and one patient was with PCoA aneurysm combined with ACHA aneurysm. The relation between origin of the branch arteries and tumor neck was determined during surgery. The relation between shape of the branch arteries and tumor body was investigated in the Spaces II, III and V of the internal carotid artery (indocyanine green fluorescence angiography was used when necessary); the aneurysms were clipped by appropriate aneurysm clip or clips combination; after clipping, microspic or endoscopic exploration and indocyanine green fluorescence angiography were performed, and re-clipping was performed in the misclipped or stenosed branch arteries.Results:During the surgery, the branch arteries of 6 patients (4 from posterior communicating artery, 1 from anterior choroidal artery, and 1 from perforator artery at the bifurcation of internal carotid artery) were misclipped, and therefore, the aneurysm clips were adjusted or replaced and then re-clipped. Aneurysms were successfully clipped in all 52 patients. Brain CT examination within 24 h of surgery showed that focal cerebral infarction in the branch artery feeding area was noted in 5 patients, of which 3 patients were accompanied by contralateral limb muscle strength decline (grading 4, grading 3 and grading 1, respectively) and medication and neurological rehabilitation were given. The other 47 patients had good general condition without special condition. During the follow-up of 9-12 months, the muscle strength of 3 patients with decreased contralateral limb strength recovered to grading 5, 4 and 2, respectively. There were no residual or recurrent aneurysms in all patients. At the last follow-up, 47 patients had Glasgow Outcome scale (GOS) scores of 5, 3 patients had GOS scores of 4, 1 patient had GOS scores of 3, and 1 patient had GOS scores of 2.Conclusion:In the treatment of low-grade internal carotid artery C7 segment aneurysms via frontolateral keyhole approach, multiple protective strategies can be adopted to actively prevent branch artery injury, which can effectively reduce the incidence of postoperative cerebral infarction and improve the prognosis.
