Name: minimally invasive thumb-sized pterional craniotomy for surgical clip ligation of unruptured anterior circulation aneurysms
Uploaded: 2015-08-11T13:00:00
Description: Watch this Scientific Journal Video about Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms at JoVE.com

The authors have no acknowledgments.

BEMÆRK: Før du udfører denne procedure, indhente alle nødvendige institutionelle godkendelse og patient samtykke. 1. Kirurgisk teknik <ol><li> Fremkalde patient med generel anæstesi. </li><li> Placer radial arteriel linje for blodtryk overvågning. </li><li> Placer patienten i liggende position på operationsstuen bordet. </li><li> Efter hovedet er fastklemt i Mayfield hoved indehaveren anvendelse af standardteknikker til en pterional kraniotomi, positionere hovedet 30 ° -45 ° med d...

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Kirurgisk klip ligering af intrakranielle aneurismer fortsat en relevant og vigtig mulighed i behandling af visse typer af aneurismer, selvom denne rolle har været aftagende i de sidste adskillige år som endovaskulær teknologi bliver sikrere og mere effektive. Endovaskulær behandling har overgået kirurgi for cerebrale aneurismer, men den højere recidiv rate efter endovaskulær behandling, lejlighedsvis behov for kirurgisk behandling efter aneurisme gentagelse fra mislykkedes endovaskulær behandling, specifikke mo...

Kirurgisk klip ligation havde været grundpillen i behandling for intrakranielle aneurismer, men er for nylig blevet meste erstattet af mindre invasive endovaskulære teknikker. 1,2 Kliniske forsøg herunder den internationale Undersøgelse af uopbrudte Intrakranielle Aneurismer (ISUIA-1 og ISUIA-2), og den internationale subarachnoide Aneurysm Trial (ISAT) har vist lavere sygelighed og dødelighed, nedsat længden af hospitalsophold, og lavere samlede regning med endovaskulær behandling i forhold til kirurgisk klip ligatur 3 -. 5. Men den højere aneurisme tilbagefald sats efter endovaskulær terapi har ført til undersøgelse af den kumulative risiko for de patienter sammenlignet med kirurgisk klemme ligering. 3,4 Kirurgisk behandling er fortsat en vigtig modalitet for aneurisme terapi, især til anterior omløb aneurismer, der har morfologier, der kan være vanskelige at behandle med endovaskulære midler. <p class = &quot;jove_content&quot;&gt; I modsætning til fremskridt i endovaskulære enheder, har kun få fremskridt i kirurgiske teknikker er foretaget for nylig. Teknikker til at gøre kirurgisk behandling mindre invasiv har medtaget supraorbital kraniotomi kombineret med øjenbryn snit til forreste cirkulation aneurismer og &quot;retractorless kirurgi&quot; for at minimere kirurgisk traume til hjernen under aneurisme klipning 6 -. 8 Disse mindre invasive kirurgiske metoder kan reducere længden af hospitalet ophold, kirurgisk sygelighed, behandling omkostninger og forbedre patienternes resultater. 9 Her præsenterer vi vores erfaringer med en minimalt invasiv tilgang til kirurgisk klip ligatur af uopbrudte intrakranielle aneurismer ved hjælp af en pterional tilgang til forreste cirkulation aneurismer udføres i en større tertiær cerebrovaskulær center og sammenligne resultaterne med en alder matchede datasæt fra Nationwide Indlæggelse Sample (NIS ). Den kirurgiske teknik vil blive revideretHerunder patientens forberedelse, hjerne afslapning, Sylvian revne dissektion, og lukning. Postoperative pleje og udlederkrav vil også blive skitseret.

<table border="0" cellpadding="0" cellspacing="0" width="963">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Mayfield Infinity skull clamp</td>
			<td style="width:125px;">Integra</td>
			<td style="width:368px;">A-1114</td>
			<td style="width:64px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Mayfield table attachment</td>
			<td style="width:125px;">Integra</td>
			<td style="width:368px;">A-1018</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">4-French Fukishima suction tip</td>
			<td style="width:125px;">Integra</td>
			<td style="width:368px;">R-8986</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Periosteal elevator (Langenbeck)</td>
			<td style="width:125px;">Codman</td>
			<td style="width:368px;">65-1116</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Metzenbaum scissors</td>
			<td style="width:125px;">Codman</td>
			<td style="width:368px;">36-5023</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Malis dissector, round angled</td>
			<td style="width:125px;">Codman</td>
			<td style="width:368px;">80-1541&#160;</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Penfield dissector, style 1</td>
			<td style="width:125px;">Codman</td>
			<td style="width:368px;">65-1015</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Lempert bone rongeur</td>
			<td style="width:125px;">Codman</td>
			<td style="width:368px;">19-1232</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Malis Irrigation Module</td>
			<td style="width:125px;">Codman</td>
			<td style="width:368px;">Module 1000</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Bovie monopolar electrocautery device</td>
			<td style="width:125px;">Codman</td>
			<td style="width:368px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Insulated blade for electrocautery device</td>
			<td style="width:125px;">Covidien</td>
			<td style="width:368px;">E1455</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Fish-hook retractors</td>
			<td style="width:125px;">Lone Star</td>
			<td style="width:368px;">3350-8G</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Pneumatic drill</td>
			<td style="width:125px;">Medtronic</td>
			<td style="width:368px;">Midas Rex MR7</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Side-cutting drill</td>
			<td style="width:125px;">Medtronic</td>
			<td style="width:368px;">F2/8TA23</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Fluted legend match head tool</td>
			<td style="width:125px;">Medtronic</td>
			<td style="width:368px;">10MH30</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Surgical scalpel No. 10,11,15</td>
			<td style="width:125px;">Bard-Parker</td>
			<td style="width:368px;">0029064 (No.10), 0018291 (No.11), 0018043 (No.15)</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Intra-operative microscope with mouthpiece</td>
			<td style="width:125px;">Leica</td>
			<td style="width:368px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Microscissors</td>
			<td style="width:125px;">V. Mueller</td>
			<td style="width:368px;">NL3785-034(st), NL3785-035(cvd)</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Rhoton dissector, #2</td>
			<td style="width:125px;">V. Mueller</td>
			<td style="width:368px;">NL3785-002&#160;</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Telfa strips</td>
			<td style="width:125px;">American Surgical</td>
			<td style="width:368px;">#80-09 (1/2x3), #80-04 (1/4x3)</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Aneurysm clip</td>
			<td style="width:125px;">Aesculap</td>
			<td style="width:368px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Raney clip applier</td>
			<td style="width:125px;">Aesculap</td>
			<td style="width:368px;">FF012R</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Synthes Matrix metal plating system</td>
			<td style="width:125px;">Synthes</td>
			<td style="width:368px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Braided absorbable surgical sutures (Vicyrl)&#160;</td>
			<td style="width:125px;">Ethicon</td>
			<td style="width:368px;">J790D (3-0), J743D (4-0)</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Braided nylon nonabsorbable surgical sutures (Nurolon) 4-0</td>
			<td style="width:125px;">Ethicon</td>
			<td style="width:368px;">C584D</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:407px;">Doppler System</td>
			<td style="width:125px;">Mizuho</td>
			<td style="width:368px;">07-150-02</td>
			<td></td>
		</tr>
	</tbody>
</table>

minimally invasive thumb-sized pterional craniotomy for surgical clip ligation of unruptured anterior circulation aneurysms

Mindre invasive kirurgiske metoder til intrakraniel aneurisme klipning kan reducere længden af ​​hospitalsophold, kirurgisk sygelighed, behandling omkostninger og forbedre patienternes resultater. Vi præsenterer vores erfaringer med en minimalt invasiv pterional tilgang til forreste cirkulation aneurismer udføres i en større tertiær cerebrovaskulær center og sammenligne resultaterne med en gammel matchet datasæt fra Nationwide Indlæggelse Sample (NIS). Fra august 2008 til december 2012, blev 22 valgfrie aneurisme udklip på patienter ≤55 år udført af den samme dual fællesskab-uddannede cerebrovaskulær / endovaskulær neurokirurg. En patient (4,5%) oplevede forbigående postoperative komplikationer. 18 af 22 patienter returnerede for opfølgning billedbehandling og der var ingen gentagelser gennem en gennemsnitlig varighed på 22 måneder. En søgning i NIS database fra 2008 til 2010 også for patienter på ≤55 år, gav 1.341 indlæggelser til kirurgisk klip ligatur af unruptmåles cerebrale aneurismer. Indlæggelse liggetid og hospital afgifter på vores institution ved hjælp af minimalt invasiv tommelfinger mellemstore pterional teknik var næsten halvdelen af ​​NIS (opholdets varighed: 3.2 vs 5,7 dage, hospital gebyrer: $ 52,779 vs. $ 101,882). Den minimalt invasiv tommelfinger mellemstore pterional kraniotomi tillader god eksponering af uopbrudte små og mellemstore supraclinoid anterior cirkulation aneurismer. Cerebrospinalvæske dræning fra centrale subaraknoidale cisterner og konstante halvmanuelle mikrokirurgiske teknikker undgå behovet for retraktorer, som kan forårsage blodudtrædninger, lokaliserede venøse infarkter og postoperativ cerebralt ødem ved retraktoren sites. Udnytte dette sæt af teknikker har gav vores patienter med en kortere hospitalsophold til en lavere pris i forhold til det nationale gennemsnit.

I øjeblikket, på vores institution over 150 aneurismer behandles årligt. Fra august 2008 til december 2012, blev 22 valgfrie aneurisme udklip ved hjælp af denne minimalt invasiv tommelfinger mellemstore pterional kraniotomi teknik til supraclinoidal aneurismer på patientens ≤55 år udført af den samme dual fællesskab-uddannede cerebrovaskulær / endovaskulær neurokirurg, der udviklede denne teknik (EMD ) (tabel 1). Denne aldersgruppe blev valgt som tidligere forsøg har vist, at kirurgisk beha...

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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

Minimalt invasiv Thumb størrelse Pterional kraniotomi for Kirurgisk Clip Ligering af uopbrudte Anteriore Circulation Aneurismer

Minimalt invasiv tommelfinger mellemstore pterional kraniotomi for aneurisme klipning har gav vores patienter med en kortere hospitalsophold til en lavere pris i forhold til det nationale gennemsnit.

Less invasive surgical approaches for intracranial aneurysm clipping may reduce length of hospital stay, surgical morbidity, treatment cost, and improve ...

Research

JoVE Journal

Medicine

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