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asbryobvrz · Wysłany: Pią 20:26, 11 Mar 2011

Anterior circulation Surgical treatment of giant aneurysms

. Carotid aneurysms in this group of large, difficult to use conventional clamping of cases: (1) narrowing the aneurysm neck to facilitate the aneurysm neck clipping: for wide neck aneurysms and the lack of tumor thrombus, or after parent artery clipping distortion narrow seriously affect the cases of parent artery patency, first braided nylon line with shrinking aneurysm neck occlusion, can be reduced to the clipped aneurysm neck without affecting the parent artery patency, and then select the appropriate folder will aneurysm Aneurysm neck clipping. (2), aneurysm neck remodeling: from a more distant from the first parent artery aneurysm with a large aneurysm clip occlusion of the artery, so close to the aneurysm neck smaller body, and then toward the direction of exchange of aneurysm neck aneurysm clip until the aneurysm neck completely clipped. (3) The method of reverse pumping ICA and aneurysm to collapse, this time is over aneurysm and arterial branches of perforating arteries to become more easily separated or even automatically with the aneurysmal wall was torn off and is conducive to aneurysm neck clip closed, but also to reduce or avoid wearing artery injury. (4) special wide neck aneurysms,[link widoczny dla zalogowanych], or parent artery of the input and output far apart,[link widoczny dla zalogowanych], or aneurysm filled with thrombus within the aneurysm neck clipping difficult, preoperative angiography and take prompt rich collateral circulation aneurysms isolated After the removal or isolation. But for poor collateral circulation, isolated ischemic symptoms may occur after using the parent artery reconstruction in order to avoid severe postoperative ischemic neurological disorders. 2 sides of the group were parent artery reconstruction,[link widoczny dla zalogowanych], anastomotic patency after angiography, the patient recovered uneventfully. Of these patients, using a large vein graft to stabilize the neck and the clinoid ICA is better than agreement on the superficial temporal artery ICA. MCA branch anastomosis, because of its diameter thick, flat, asked a lot of blood flow within the pass, can effectively prevent ischemic brain damage; also largely restored normal blood flow dynamics of intracranial ICA, ICA may be ligated to avoid intracranial hemodynamic changes induced by contralateral new aneurysm. In addition,[link widoczny dla zalogowanych], in order to eliminate the large aneurysm mass effect, usually in the aneurysm or isolated, the out residual blood within the aneurysm, or aneurysm cut out intraluminal thrombus, or nerve tissue without causing additional damage in the premise , aneurysm excision, in order to facilitate the recovery of neurological function involved. Giant intracranial aneurysms is still a high mortality rate and surgical morbidity,[link widoczny dla zalogowanych], mortality reported a 22% 5%, surgical morbidity was 6% ~ 23% _2J. With advances in microsurgical techniques, postoperative mortality and disability rates on the decline Is, 6】. The results suggest that this group of treatment of intracranial giant aneurysms of anterior circulation superiority of active surgical treatment.