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Hypertensive intracerebral hemorrhage (ICH) is mostly single in basal ganglia, thalamus and pons. Simultaneous hemorrhage in other brain regions is relatively rare, accounting for only 5.6% of all hemorrhagic strokes, while bilateral symmetrical hemorrhage is extremely rare. A case of bilateral basal ganglia symmetrical hemorrhage is reported for clinical reference.
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Objective:To explore the value of application and manipulation technique of neuroendoscope in microsurgical clipping of ruptured posterior communicating artery(PCoA)aneurysms via keyhole approaches.Methods:From January 2018 to December 2020, the clinical data of 52 patients who received microsurgical clipping for ruptured via keyhole approach were retrospectively analysed. Forty-one patients had the intraoperative endoscopic monitoring. The supraorbital keyhole approach or pterional keyhole approach was applied based on the characteristics of the aneurysms. According to the in-surgery requirement, a 30° rigid neuroendoscope was used before and/or after clipping. All patients entered postoperative follow-up in outpatient clinic and were evaluated with the modified Rankin Scale(mRS).Results:All 52 patients had 52 ruptured PCoA aneurysms. Eighteen of the patients were treated via supraorbital keyhole approach and 34 via pterion keyhole approach. Pre-and post-clipping endoscopic observation were carried out in 12 cases and 29 only with post-clipping endoscopic observation. Residual aneurysmal neck was detected in 3 patients. Missed clipping of perforators was found in 2 patients and followed by proper adjustment of clips. All patients received follow-up angiographic examinations. Total obliteration of the aneurysm and an intact of internal carotid artery and PCoA were found in 41 patients by the intraoperative endoscopic observation. Two residual aneurysmal neck were detected in 11 patients without intraoperative endoscopic observation. After 11 to 45 months of follow-up, all patients had good recovery(mRS 0-1).Conclusion:It is a safe and effective method with endoscopic observation during microsurgical clipping procedure for ruptured PCoA aneurysms via keyhole approaches. It can effectively make up for the insufficient visual angle of microscope, realise the anatomical relationship between the aneurysm and adjacent structures, and avoid residual aneurysmal neck and an iatrogenic injury to the parent artery and perforators.
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Objective To investigate the value of neuronavigation system in the keyhole microsurgical opera鄄tion for distal intracranial artery aneurysms (DIAA). Methods The clinical data of 16 cases with DIAA who were treated by via keyhole approaches, from January, 2013 to December, 2018, were analyzed retrospectively. Ten a鄄neurysms located in anterior cerebral artery(ACA), 3 in posterior inferior cerebellum artery(PICA) and 3 in perforator artery (PA).The optimal skin incision and craniotomy were designed with assistence of neuronavigation system preop鄄eratively, and lesions were located precisely under the guidance of neuronavigation system during microsurgery before clipping or resection. Angiography was performed before discharge, and clinic followed-up was conducted monthly till 6 months after surgery. Results The systematic error of neuronavigation system ranged from 0.5 mm to 1.0 mm, with an average of 0.6 mm.All 16 aneurysms were explored and managed successfully with the guidance of neuronav鄄igation system without aneurysm premature rupture nor neuronavigation-related complications. Absolute occlusion of all aneurysms was documented angiographically after surgery. Of all cases, 2 experienced shunt procedure due to de鄄layed hydrocephalus.During 6 months follow-up period, all 16 cases recovered well. Conclusion Neuronavigation system can precisely locate the deep-seated DIAA, contribute to the preoperative planning of microsurgery via key鄄hole approaches and avoid evitable injury during excessive manipulation. The noninvasive, rapid and contrast-en鄄hanced CT images of head was an ideal data source for the neuronavigation system.
ABSTRACT
Objective@#To investigate the value of neuronavigation system in the keyhole microsurgical operation for distal intracranial artery aneurysms(DIAA).@*Methods@#The clinical data of 16 cases with DIAA who were treated by via keyhole approaches, from January, 2013 to December, 2018, were analyzed retrospectively. Ten aneurysms located in anterior cerebral artery(ACA), 3 in posterior inferior cerebellum artery(PICA) and 3 in perforator artery(PA). The optimal skin incision and craniotomy were designed with assistence of neuronavigation system preoperatively, and lesions were located precisely under the guidance of neuronavigation system during microsurgery before clipping or resection. Angiography was performed before discharge, and clinic followed-up was conducted monthly till 6 months after surgery.@*Results@#The systematic error of neuronavigation system ranged from 0.5 mm to 1.0 mm, with an average of 0.6 mm. All 16 aneurysms were explored and managed successfully with the guidance of neuronavigation system without aneurysm premature rupture nor neuronavigation-related complications. Absolute occlusion of all aneurysms was documented angiographically after surgery. Of all cases, 2 experienced shunt procedure due to delayed hydrocephalus. During 6 months follow-up period, all 16 cases recovered well.@*Conclusion@#Neuronavigation system can precisely locate the deep-seated DIAA, contribute to the preoperative planning of microsurgery via keyhole approaches and avoid evitable injury during excessive manipulation. The noninvasive, rapid and contrast-enhanced CT images of head was an ideal data source for the neuronavigation system.
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Objective To discuss the clinical efficacy of surgery for chronic subdural hematoma assisted by rigid neuroendoscope and its surgical techniques. Methods Clinical data of 161 patients with chronic subdural hematoma from August 2009 to December 2015 was analyzed retrospectively. 74 of them experienced surgeries assisted by rigid neuroendoscope (endoscope group) and other 87 cases were operated without neuroendoscope (routine group) during the same period. Results Although there were significant difference in operative duration between the two groups, complications, ratio of total removal of hematoma after surgery, postoperative inpatient duration and recurrent rate of hematoma were more advantageous in endoscope group. The operative duration of endoscope group with (112.68 ± 34.86) min was longer than that of routine group with (74.11 ± 28.23) min (t = 7.75, P = 0.000), while the postoperative inpatient duration of endoscope group with (8.23 ± 2.01) d was shorter than that of another group with (10.79 ± 5.02) d (t = -4.12, P = 0.000). There were no surgical associated complications in endoscope group, but 1 patient in routine group experienced intracerebral hematoma of frontal lobe and associated aphemia. Total removal of hematoma was confirmed in endoscope group with 98.65% (73/74), which was higher than that in routine group with 86.21% (75/78) (χ2 = 8.34, P = 0.004). Hematoma recurrence was found in 16 cases of routine group (18.39%), but more superiority in endoscope group with 1.35% (χ2 = 12.29, P = 0.000). Outpatient follow-up was carried out in all patients from 6 to 38 months with an average duration of 30.06 months. In 17 cases with recurrent hematoma during follow-up, 15 of them were cured by a second surgery, and another 2 patients were cured by atorvastatin. Conclusion As a simple, safe and effective technique, the application of rigid neuroendoscope during surgery for chronic subdural hematoma is more advantage than routine surgery. A self-made suction with adjustable soft curved tip is suitable for such procedure.