intracranial aneurysm surgery

An intracranial aneurysm with a maximum diameter of more than 2.5 cm is called a giant aneurysm, and its incidence is about 5% (3% to 13%) of all intracranial aneurysms. It can occur in any common part of an intracranial aneurysm, but More common in the intracranial segment of the internal carotid artery, middle cerebral artery, anterior communicating artery, basilar artery bifurcation and basilar artery trunk. The surgical treatment of giant aneurysms is characterized by: the neck is wide and hard, difficult to clamp or can not be clamped; the tumor has a mass effect and is not suitable for endovascular embolization. Therefore, different methods or a combination of several methods must be used to treat an aneurysm depending on the specific situation. Treatment of diseases: intracranial aneurysms Indication 1. Giant aneurysms have occupational symptoms, hemorrhage, and cerebral ischemia or cerebral infarction caused by thrombus shedding in the tumor capsule. 2. The patient's physical condition can tolerate the operator. Surgical procedure Tumor neck clipping Although the neck neck clipping is the best way to treat an aneurysm, when the giant aneurysm is treated, the neck is too wide or the neck is hardened or calcified, so the clip is not tight, or the tumor clip will slide to the artery. Causes arterial stenosis or occlusion. Tumor clips of various lengths, shapes, angles, and clipping forces must be prepared for use before surgery. (1) Single tumor clip clamping method: temporarily block the proximal and distal segments of the tumor-bearing artery and evacuate the blood in the tumor capsule, and clamp the tumor neck with a tumor clip with strong clamping force. This is only possible if the aneurysm is slightly thin and soft in the neck. If the clamping is not tight, an auxiliary tumor clip can be used to strengthen the clamping force. (2) Multi-tumor clip clamping method: clip the neck with multiple tumor clips, clip the neck with tandem clipping, or clip the neck with parallel clipping. That is, a plurality of straight tumor clips are juxtaposed in parallel and the tumor capsule is vertically clamped to the tumor-bearing artery. 2. Retrograde aspiration decompression The aneurysm located next to the bed can not control the proximal segment of the tumor-bearing artery. This method can be used to evacuate the aneurysm sac to facilitate the separation and clipping of the aneurysm. 3. Aneurysm suture (aneurysmorrhaphy) After temporarily blocking the proximal and distal segments of the tumor-bearing artery, the tumor capsule was dissected to remove the thrombus, the excess tumor wall was removed, and the blood flow channel was reconstructed by plastic suture. 4. Aneurysm isolation (trapping of aneurysms) The proximal and distal segments of the aneurysm bearing artery are permanently clamped to isolate the aneurysm. However, it must be ensured that there is sufficient collateral blood supply in the distal blood supply area of the tumor-bearing artery, otherwise vascular bypass bridging should be performed at the same time. For example, the internal carotid aneurysm of the sacral segment, the internal carotid aneurysm of the cavernous sinus segment, and the aneurysm of the bedside aneurysm should be performed in the internal carotid artery-venous-pedicular upper carotid artery anastomosis, or the superficial temporal artery-brain For the anastomosis of the middle cerebral artery, the basilar artery anastomosis should be performed in the superficial temporal artery-posterior cerebral artery anastomosis. The vertebral artery aneurysm should be performed in the occipital artery-posterior inferior cerebellar anastomosis. Surgery. 5. Aneurysm wrapping (wrapping aneurysms) Wrap or cover an aneurysm with cotton, fascia, gauze or polymer glue to reinforce the tumor wall to prevent it from rupturing, but this method will increase the occupancy effect, and the foreign body reaction is large, still can not prevent aneurysm bleeding And growing up, it is now used less. complication 1. Cerebral ischemia. 2. Cerebral embolism.