Abstract：
OBJECTIVE:We describe the technique for surgical "transaneurysmal" embolectomy in a patient with subarachnoid hemorrhage and multiple cerebral aneurysms who manifested large-vessel occlusion during coil embolization. METHODS:An 84-year-old woman with subarachnoid hemorrhage and bilateral internal carotid artery (ICA)-posterior communicating artery and bilateral middle cerebral artery aneurysms (MCAs) was admitted to our institution. We performed clipping to the left ICA and MCAs; however, we could not find the rupture point of both aneurysms. We chose to treat 2 aneurysms on the other side by coil embolization. After complete coil embolization of a right ICA aneurysm, angiograms showed occlusion of the right MCA just proximal to an MCA aneurysm. Considering the risk of bleeding of an untreated MCA distal to the occlusion by endovascular thrombectomy, we performed open transaneurysmal embolectomy at the occlusion site and surgical clipping of the MCA. After cutting the aneurysmal wall, we inserted a suction tube into the cut surface of the aneurysm. The clot was gradually and completely pulled through the cut surface of the aneurysm. Finally, the aneurysm was completely clipped with titanium clips to preserve the M1 and M2 branches. DISCUSSION:Different from usual surgical thrombectomy, suturing the vessel wall is not required for transaneurysmal embolectomy and the area of brain ischemia is confined. Aneurysms with the fragile wall may rupture during clearance of tissue on the aneurysmal surface, and suction may increase vessel damage. CONCLUSION:Transaneurysmal thrombectomy may be useful and safe for large-vessel occlusion just distal to cerebral aneurysms.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Suzuki M,Mizunari T,Iwamoto N,Morita Adoi
10.1016/j.wneu.2018.03.053subject
Has Abstractpub_date
2018-06-01 00:00:00pages
113-116eissn
1878-8750issn
1878-8769pii
S1878-8750(18)30531-Xjournal_volume
114pub_type
杂志文章abstract：:When used in medicine, endoscopy describes a procedure used to see inside various parts of the body, such as the interior surfaces of an organ, by inserting a tube through a natural or created orifice. The instrument may have a rigid (borescope) or flexible (fiberscope) tube; it provides an image for visual inspection...
journal_title：World neurosurgery
pub_type： 历史文章,杂志文章,评审
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journal_title：World neurosurgery
pub_type： 杂志文章,评审
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journal_title：World neurosurgery
pub_type： 杂志文章
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journal_title：World neurosurgery
pub_type： 杂志文章
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pub_type： 杂志文章,多中心研究
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journal_title：World neurosurgery
pub_type： 杂志文章,评审
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journal_title：World neurosurgery
pub_type： 杂志文章
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journal_title：World neurosurgery
pub_type： 杂志文章
doi：10.1016/j.wneu.2016.06.088
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pub_type： 杂志文章
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pub_type： 杂志文章
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journal_title：World neurosurgery
pub_type： 杂志文章,评审
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更新日期：2013-02-01 00:00:00
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journal_title：World neurosurgery
pub_type： 杂志文章
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pub_type： 杂志文章
doi：10.1016/j.wneu.2015.07.016
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pub_type： 杂志文章
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pub_type： 杂志文章,meta分析
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pub_type： 杂志文章
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pub_type： 杂志文章
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pub_type： 杂志文章
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pub_type： 杂志文章,评审
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更新日期：2021-01-01 00:00:00
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