One-stop procedure in DSA hybrid operating room for treatment of ruptured intracranial complex aneurysms combined with cerebral hematomas / 中国介入影像与治疗学

ABSTRACT

Objective To explore the clinical value of one-stop procedure in DSA hybrid operating room for treatment of ruptured intracranial complex aneurysms combined with cerebral hematomas. Methods: Eleven patients within 72 h after onset of ruptured intracranial complex aneurysms combined with cerebral hematomas without cerebral hernia underwent one-stop procedure in DSA hybrid operating room. Intraoperative DSA was used to evaluate whether the aneurysm involved the parent artery. The aneurysms were treated with intracranial aneurysm isolation combined with extra-intracranial bypass under the guidance of DSA or temporary balloon occlusion assisted shape clipping. And the hematomas were removal appropriately. Intraoperative situation of hybrid surgery was monitored in real time. Intraoperative and postoperative complications were recorded. The patients were followed up after discharge. CTA examinations were performed 6 months after operation. Glasgow outcome score (GOS) was used to evaluate the efficacy when patients were discharged and the last follow-up. When the scores were equal or greater than 4, the discharge was considered as effective treatment. Results: Superficial tempora1 artery (STA)-middle cerebral artery (MCA) bypass were performed in 5 patients smoothly. Intraoperative DSA revealed that the bridge vessel was unobstructed, and the aneurysms were isolated in one stage. Six patients were treated with shape clipping. Mistakenly clipping of perforator vessels occurred in 3 patients, and incomplete clipping occurred in 1 patient. The clamping effect was satisfactory after adjusting the positions of aneurysm clips. There were 2 cases of focal infarction and 1 case of epilepsy after operation. The proportion of patients responded well to treatment was both 81.82% (9/11) when discharged and the last follow-up, respectively. No recurrence, stenosis of anastomotic nor parental artery was detected among 11 patients 6 month after operation. Conclusion: Patients with complex aneurysms associated with intracranial hematomas impossible treated with single surgical clipping or endovascular intervention can be cured with one-stop procedure in DSA hybrid operating room with relatively satisfied results.