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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.
RESUMO
Objective To explore the impact of Microsurgical operation through lateral fissure-insula lobe approach in the treatment of hypertensive cerebral hemorrhage in basal ganglia region on the clinical curative effect.Methods Selected 90 cases of patients with hyper-tensive cerebral hemorrhage in basal ganglia region in our hospital from April 2013 to December 2015.According to the random number table method,they were divided into the observation group and the control group.Regarded the even numbers as the observation group while the odd numbers as the control group,with 45 cases in each group.Patients of the two groups were all performed general anaesthesia with tracheal in-tubation.And patients of the control group were given large trauma craniotomy,while patients of the observation group were treated by micro-surgical operation through lateral fissure-insula lobe approach.Recorded the situation of surgery and postoperative recovery of patients in the two groups.In addition,compared the postoperative complications and evaluated living conditions of the two groups through activity of daily living scale(ADL)half a year after surgery.Results The good rate of recovery in the observation group was 84.44% (38 /45),while it was 51.11%(23 /45)in the control group,and there was statistically significant difference between the two groups(χ2 =11.447,P =0.000).Be-sides,the mortality rate of the observation group was 0(0 /45)half a year after surgery,while it was 8.89%(4 /45)in the control group,and there was statistically significant difference between the two groups(χ2 =4.186,P =0.041).The operation time of observation group and the automatic opening time in the observation group were obviously shorter than that of the control group(P <0.05).Moreover,the hematoma clearance rate and GCS score of the observation group 1 week after operation were significantly higher than those of the control group (P <0.05).The incidence of postoperative complications of the observation group was 8.89%(4 /45),which was significantly lower than 31.11%(14 /45)in the control group,and there was significant difference(P <0.05).Conclusion It has many advantages such as shorter operative time,faster postoperative recovery,and higher hematoma clearance rate to apply microsurgical operation through lateral fissure-insula lobe approach in the treatment of hypertensive cerebral hemorrhage in basal ganglia region.Besides,it pays attention to protecting cerebral vascular of patients.The clinical treatment effect is ideal and safe.Therefore,it is worth popularizing in clinical application.