Clinical Article
Clinical efficacy of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms
Wang Gang, Wen Yunyu, Liao Yonghong, Zhang Guozhong, Li Mingzhou, Chen Siyuan, Qi Songtao, Feng Wenfeng
Published 2020-01-28
Cite as Chin J Neurosurg, 2020,36(01): 48-51. DOI: 10.3760/cma.j.issn.1001-2346.2020.01.013
Abstract
ObjectiveTo explore the outcome of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms.
MethodsA retrospective analysis was conducted on the clinical data of 13 patients with MCA complicated aneurysm admitted to Department of Neurosurgery, Nanfang Hospital of Southern Medical University from January 2015 to February 2019. All patients underwent a unilateral craniotomy with transpterional approach in the hybrid operating room. Multiple aneurysm clips were used to clip the aneurysm during the operation. Of the 13 patients, 7 were ruptured aneurysms, 4 were Hunt-Hess grade Ⅰ, 1 were Ⅲ, and 2 were Ⅳ; 6 were unruptured aneurysms. There were 19 aneurysms in 13 patients, of which 5 were single MCA aneurysms, 1 was bilateral MCA aneurysms, and the remaining 7 patients were single MCA aneurysms. The aneurysm embolization was evaluated by Raymond classification, and the clinical outcome was evaluated by modified Rankin Scale (mRS) criteria.
ResultsThirteen patients with 19 aneurysms underwent successful clipping. A total of 60 aneurysm clips were used. For each aneurysm, we used 1 to 6 (3.2 ± 1.6) clips. After aneurysm clipping, intraoperative angiographic review revealed clipping insufficiency (Raymond grade II) in 4 aneurysms, and 2 patients with parent aneurysm stenosis. After adjustment of the aneurysm clip, all aneurysms were completely occluded (Raymond grade Ⅰ) and the parent aneurysm had no stenosis. Only one patient developed postoperative cerebral infarction in the basal ganglia and slight hemiplegia resulting from occlusion of a branch emanating from the aneurysm wall. At discharge, the mRS was 0 in 10 patients, 2 in 2 patients, and 5 in 1 patient. Thirteen patients were followed up for 6 to 36 months (median: 17.3 months). The mRS was 0 in 10 cases, 1 in 2 cases, and 4 in 1 case. In 6 cases of re-examination, none of the aneurysms recurred.
ConclusionThe use of multiple aneurysm clips in the hybrid operating room to shape and clamp MCA complex aneurysms is effective and has few complications.
Key words:
Intracranial aneurysm; Middle cerebral artery; Microsurgery; Parallel clipping technique; Hybrid surgery
Contributor Information
Wang Gang
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Wen Yunyu
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Liao Yonghong
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Zhang Guozhong
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Li Mingzhou
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Chen Siyuan
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Qi Songtao
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Feng Wenfeng
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
