Analysis of balloon-assisted occlusion technique in hybrid operation of paraclinoid aneurysms of internal carotid artery / 中国脑血管病杂志

ABSTRACT

Objective To evaluate the safety and effectiveness of balloon-assisted clipping of paraclinoid aneurysms with hybrid operatioa Methods From July 2011 to July 2018,119 consecutive patients treated with the balloon-assisted clipping of paraclinoid aneurysms at the Hybrid Operation Room, Department of Neurosurgery, West China Hospital,Sichuan University were enrolled retrospectively. Patients' age, gender, Hunt-Hess grade, ocular symptoms at admission, and location and size of aneurysms were collected. Balloon-assisted craniotomy for clipping aneurysms was used ,95 of them were treated with detachable balloon at the proximal end of the aneurysms, and 24 were blocked by balloons in the aneurysm neck straddles. During the operation,the state of discharge after surgery,and the follow-up results at 6 months after discharge of the patients were observed. The operation effect and complications were evaluated.Results Of the 119 patients,94 were female and 25 were male;aged 27 -82 years (mean 57 ± 15 years). Twenty-nine patients (24. 4%) showed decreased vision,62 (52. 1%) had dizziness and headache symptoms. The remaining 28 had no obvious symptoms. Hunt-Hess grade III in 3 cases (2. 5%) ,grade I-II in 42 cases (35. 3%) ,the remaining 74 (62. 2%) were unruptured aneurysms. Twenty-one patients (17.6%) had clinoid segment aneurysms, 82 (68.9%) had ophthalmic segment aneurysms, and 16 (13. 4%) had posterior communication aneurysms. The maximum diameter of the aneurysms was 5 to 35 mm (mean 19 ±7 mm) ,and the aneurysm diameter of 112 patients (94.1%) were > 10 mm. The aneurysms were successfully clipped in 111 cases (93. 3%) during the operation. Five patients had aneurysm neck and internal carotid artery lacerations during the clipping,and one was obviously unable to be clipped due to the neck calcification. After Hyperglide balloon saddle block, 1 patient occurred balloon rupture during the puncture and aspiration of the aneurysmal cavity. When the balloon was blocked in 1 case, balloon displacement occurred during repeated filling adjustment of aneurysm clips and the distal end detached into an aneurysm cavity and was clipped by an aneurysm clip. Three patients died at discharge, they were all aneurysm neck and internal carotid artery lacerations, and they were patients with massive cerebral infarction after aneurysm tapping. Five patients were in a coma; another 6 had hemiplegia symptoms. The remaining 105 patients (88. 2%) had no obvious neurological deficits at discharge. Six months after discharge, 11 patients with neurological deficits were followed up by telephone. Among the 5 comatose patients,3 died within one week after discharge. The consciousness of 2 cases changed from coma to indifference, their left limb muscle strength was grade III,and blurred vision was the same as before operation. Of the 6 hemiplegic patients, 1 died 3 months after discharge, and the other 5 had clear consciousness and their blurred vision was the same as before operation, all had limb hemiplegia, and their muscle strength was grade I - U - Conclusion Hybrid surgery with balloon-assisted clipping technique may effectively treat complex paraclinoid aneurysms.