DOI: https://doi.org/10.22263/2312-4156.2024.5.56
A.I. Ahremchuk
Radicality assessment of clipping in patients with unruptured middle cerebral artery aneurysms
Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic of Belarus
Vestnik VGMU. 2024;23(5):56-64.
Abstract.
Complications arising during clipping of cerebral aneurysms, including incomplete aneurism disconnection from blood flow, compression of afferent, efferent and perforating arteries with clips, are an important problem in the cerebral arterial aneurysms surgery. To solve this problem, it is necessary to apply methods of intraoperative assessment of blood flow and clipping control. Research design: prospective, open, randomized, controlled study.
Objectives. To study the effectiveness of methods for the intraoperative blood flow assessment, aneurysm clipping control in patients with unruptured middle cerebral artery aneurysms.
Material and methods. The study included 142 patients with unruptured middle cerebral artery aneurysms who underwent microsurgical clipping of aneurysms at RNPC Neurology and Neurosurgery from 2018 to 2022, divided into 2 groups according to methods of the blood flow intraoperative diagnostics and microsurgical clipping control of cerebral aneurysms.
Results. The use of intraoperative fluorescence video angiography during microsurgical clipping of neovascular aneurysms of the middle cerebral artery was found to increase the radicality of AA clipping from 81.5% to 96.3% (p=0.023). Incomplete clipping of the aneurysm neck was revealed in 8 (7.5%) patients after aneurysm clipping and intraoperative fluorescence video angiography with indocyanine green, resulting in clip repositioning in 5 (4.7%) patients and placement of an additional clip in 3 (2.8%) patients. Clip compression of the M2 segment of the SMA was revealed in 5 (4.7%) patients, which required repositioning of the Yasargil clip.
Conclusions. Intraoperative fluorescence video angiography with indocyanine green allows confirming the adequacy of clip placement on the aneurysm and its radical disconnection from blood flow; to reveal clip compression of afferent, efferent and perforating arteries that permits to correct improper Yasargil clip placement in time.
Keywords: clipping of cerebral aneurysms, intraoperative fluorescence video angiography, indocyanine green.
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Submitted 05.08.2024
Accepted 18.10.2024
Information about authors:
A.I. Ahremchuk – neurosurgeon of the neurosurgical department №2, Republican Research and Clinical Center of Neurology and Neurosurgery,
e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Anton I. Ahremchuk.
