Microcirugía asistida por endoscopia en el clipado de aneurismas gigantes y del segmento carotídeo comunicante posterior / Endoscopic assited microsurgery for clipping of giant aneurysms and carotid portion of posterior communicating aneurysms

Objetivo. Describir la utilidad de la endoscopia en el clipado microquirúrgico de aneurismas cerebrales. Descripción: Paciente de 62 años de edad con diagnóstico de aneurisma gigante de la arteria carótida interna (ICA) asociado amúltiples aneurismas, uno de ellos en el segmento carotídeo comunicante posterior (Pcom). Intervención. Se resolvió el aneurisma gigante carotídeo y el comunicante posterior con técnica microquirúrgica mediante el clipado,y éste último se clipó con la asistencia del endoscopio. Conclusión. En casos con aneurismas de ICA gigantes y aneurismas ICA-PcomA la microcirugía asistida por endoscopia provee acceso a las áreas ocultas al microscopio, permitiendo una apropiada oclusión del cuello aneurismático con preservación de perforantes

Objective. To describe the importance of the aid of the neuroendoscopein the microsurgery of cerebral aneurysms. Description. 62 years old female patient with an internal carotidartery giant aneurysm (ICA) and multiple aneurysms, one of them in the posterior communicant carotid segment (pcom). Intervention. Both of them were treated with microsurgery, and the pcom aneurysm was clipped with the assistance of endoscopy. Conclusion. In cases with giant and pcom aneurysms the endoscope assisted microsurgery is useful, providing good access to hidden fields to microscope, allowing a properlyocclusion and preservation of perforators branches.

Clipado de aneurismas grandes y gigantes asistidos por técnicas de compresión por succión retrógrada / Assisted clipping of giant and big aneurysms by the technique of decompression by retrograde suction

Objetivo. Presentar la experiencia del Hospital Fujita Health University en el clipado de aneurismas cerebrales de tamaño grande y gigante asistida por descompresión por succión retrógrada, analizando sus ventajas y desventajas.Material y método. Análisis retrospectivo de 30 pacientes con diagnóstico de aneurismas cerebrales grandes y gigantes tratados por clipado asistido por descompresión succión retrógrada tratados entre Noviembre 2005 y Junio 2010. La técnica quirúrgica y el pronóstico fueron revisados. Resultados. Todos los aneurismas fueron clipados correctamente, y posteriormente se realizaron angiotomografías 3D o angiografías con sustracción digital, demostrando permeabilidad de ramos perforantes, y clipado aneurismático sin cuello remanente. En esta serie no hubo mortalidad postoperatoria. Conclusión. La técnica de descompresión por succión retrógrada es de gran utilidad en el tratamiento definitivo de aneurismas grandes y gigantes.

Use of multiple clips for arterial reconstruction in wide neck intracranial anterior circulation aneurysms

Aneurysm clips of different shapes, sizes, fenestrated or non fenestrated can be applied for reconstruction of the arteries in cases of wide necked aneurysms. By fashioning different clips and applying them to the aneurysmal neck in patients with wide necked aneurysms, we describe the method of approximation of the inner walls of the neck of the aneurysm extending to the parent artery leading to complete exclusion of the aneurysm from the circulation. This method also confirms the approximation of the intimae on both the sides of the neck. After exposing the aneurysm, its parent artery and the perforators, the aneurysm neck is carefully dissected; the perforating arteries are also carefully dissected away. Appropriate clip selection is made and clip is applied to the neck of the aneurysm so that the walls of aneurysm which extend into the parent artery are also approximated, thus no remnant of the aneurysm is left behind, in the part extending into the parent vessel. Repeat angiograms done after 3 months of surgery showed no regrowth, or incomplete occlusion of the aneurysm. This method of clip application avoids any recurrence or regrowth of the aneurysm. The greatest advantage of this method of the clip occlusion is that it takes care of the part of the aneurysm which extends into the parent artery, so that even the minimal possibility of any aneurysmal remnant is ruled out