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

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MERK: Før du utfører denne prosedyren, innhente all nødvendig institusjonell godkjenning og pasienten samtykke. 1. kirurgisk teknikk <ol><li> Indusere pasient med narkose. </li><li> Plasser radial arteriell linje for blodtrykksmåling. </li><li> Plasser pasienten i liggende stilling på operasjonsbordet. </li><li> Etter at hodet er festet i Mayfield hodet holder med standard teknikker for en pterional craniotomy, plasserer hodet 30 ° -45 ° med ipsilaterale side opp mot taket, med unnt...

<ol>
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Kirurgisk klipp ligation av intrakranielle aneurismer fortsatt et relevant og viktig alternativ i behandling av visse typer av aneurismer, men denne rollen har vært avtagende de siste årene som endovaskulær teknologien blir tryggere og mer effektiv. Endovaskulær behandling har overgått kirurgi for cerebrale aneurismer, men jo høyere tilbakefall etter endovaskulær behandling, sporadisk behov for kirurgisk behandling etter aneurisme tilbakefall fra mislykkede endovaskulær behandling, bestemte morfologi gjør endov...

Kirurgisk klipp ligation hadde vært en bærebjelke i behandling for intrakraniale aneurismer men har nylig blitt fortrengt det meste av mindre invasive endovaskulære teknikker. 1,2 Kliniske studier inkludert International Study of Unruptured Intrakraniale aneurismer (ISUIA-1 og ISUIA-2), og International subarachnoid Aneurysm Trial (ISAT) har vist lavere sykelighet og dødelighet, redusert liggetid og lavere total kostnad, med endovaskulær behandling i forhold til kirurgisk klipp ligation 3 -. 5 Men jo høyere aneurisme tilbakefall etter endovaskulær terapi har ført til undersøkelse av den kumulative risiko for pasientene sammenlignet med kirurgiske klips ligering. 3,4 Kirurgisk behandling er fremdeles et viktig modalitet for aneurisme terapi, spesielt for fremre sirkulasjons aneurismer som har morfologier som kan være vanskelige å behandle med endovaskulære midler. <p class = &quot;jove_content&quot;&gt; I motsetning til fremskritt i endovaskulære enheter, har noen fremskritt i kirurgiske teknikker er gjort nylig. Teknikker for å gjøre kirurgisk behandling mindre invasiv har tatt supraorbital craniotomy kombinert med øyenbryn snittet for anterior sirkulasjon aneurismer og &quot;retractorless kirurgi&quot; for å minimere kirurgiske traumer til hjernen under aneurisme klipping 6 -. 8 Disse mindre invasive kirurgiske tilnærminger kan redusere lengden på sykehus bo, kirurgisk sykelighet, behandling kostnader og forbedre pasientens utfall. 9 Her presenterer vi vår erfaring med en minimal invasiv tilnærming til kirurgisk klipp ligation av unruptured intrakranielle aneurismer med en pterional tilnærming for fremre sirkulasjons aneurismer utført i en større tertiær cerebrovaskulær sentrum og sammenligne resultatene med en alder matchet datasett fra Nationwide Inpatient Sample (NIS ). Den kirurgiske teknikken vil bli anmeldt, Inkludert pasient forberedelse, hjerne avslapning, Sylvian sprekken disseksjon, og nedleggelse. Postoperativ behandling og utslippskravene vil også bli skissert.

<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 tilnærminger for intrakraniell aneurisme klipping kan redusere liggetid, kirurgisk sykelighet, behandling kostnader og forbedre pasientens utfall. Vi presenterer vår erfaring med en minimal invasiv pterional tilnærming for fremre sirkulasjons aneurismer utført i en større tertiær cerebrovaskulær sentrum og sammenligne resultatene med en gammel matchet datasett fra Nationwide Inpatient Sample (NIS). August 2008 til desember 2012 ble 22 valgfrie aneurisme utklipp på pasienter ≤55 år utføres av samme dual fellesskap trente cerebrovaskulær / endovaskulær nevrokirurg. En pasient (4,5%) opplevde forbigående postoperative komplikasjoner. 18 av 22 pasienter som returneres for oppfølging bildebehandling og det var ingen tilbakefall gjennom en gjennomsnittlig varighet på 22 måneder. Et søk i NIS databasen fra 2008 til 2010 også for pasienter i alderen ≤55 år, ga 1341 sykehusinnleggelser for kirurgisk klipp ligation av unruptfigurert cerebrale aneurismer. Innleggelse liggetid og sykehus avgifter ved vår institusjon ved hjelp av minimal invasiv tommelstore pterional teknikken var nesten halvparten av NIS (lengde på oppholdet: 3,2 vs 5,7 dager, sykehus avgifter: $ 52 779 vs $ 101 882). Den minimalt invasive tommelfingerstore pterional craniotomy gir god eksponering av unruptured små og mellomstore supraclinoid anterior opplags aneurismer. Cerebrospinalvæsken drenering fra sentrale subarachnoid sisterner og stadige bimanual mikrokirurgiske teknikker unngå behovet for Saker som kan føre til blåmerker, lokalisert venøse infarkter, og postoperativ hjerneødem ved tilbaketrekkingshylsen nettsteder. Utnytte denne sett av teknikker har gitt våre pasienter med et kortere sykehusopphold til en lavere pris i forhold til landsgjennomsnittet.

Foreløpig ved vår institusjon over 150 aneurismer behandles årlig. August 2008 til desember 2012 ble 22 valgfrie aneurisme klipp som bruker dette minimalt invasive tommelfingerstore pterional craniotomy teknikk for supraclinoidal aneurismer på pasientens ≤55 år utføres av samme dual fellesskap trente cerebrovaskulær / endovaskulær nevrokirurg som utviklet denne teknikken (EMD ) (tabell 1). Denne aldersgruppen ble valgt som tidligere studier har vist at kirurgisk behandling av aneurismer hos pa...

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

Minimal Invasive Thumb størrelse Pterional kraniotomi for Kirurgisk Clip Ligering av Unruptured Fremre Opplags aneurismer

Minimal invasiv tommelstore pterional craniotomy for aneurisme klipping har gitt våre pasienter med et kortere sykehusopphold til en lavere pris i forhold til landsgjennomsnittet.

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

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