gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Suction decompression device for giant aneurysms: technical note

Meeting Abstract

Suche in Medline nach

  • T. Martens - Neurochirurgische Klinik, Universitätsklinikum Eppendorf Hamburg
  • N.O. Schmidt - Neurochirurgische Klinik, Universitätsklinikum Eppendorf Hamburg
  • J. Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Eppendorf Hamburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP13-09

DOI: 10.3205/09dgnc395, URN: urn:nbn:de:0183-09dgnc3954

Veröffentlicht: 20. Mai 2009

© 2009 Martens et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Therapeutic approaches in intracranial giant aneurysms are associated with a mortality rate of 10–30%. Therefore an interdisciplinary approach of endovascular and neurosurgical techniques is required which should provide a bouquet of tools including stenting, parent-vessel occlusion as well as bypass techniques.

Methods: A 38-year-old woman presented with headache and progressive quadrantanopia. CT-imaging and angiography revealed a giant aneurysm of the right internal cerebral artery (ICA) distal from the ophthalmic artery measuring 28mm in diameter and compromising the anterior cerebral artery and the optic nerve. Endovascular therapy options were not feasible due to a wide aneurysm neck and insufficient cross-flow. Thus direct clipping of the aneurysm had to be performed using the suction decompression technique.

Results: First the common carotid artery and its bifurcation were exposed extracranially to provide a proximal vascular control and to place a catheter for suction into the thyroid artery. Then frontotemporal craniotomy, followed by resection of the anterior clinoid process was performed. Trapping the parent-vessel segment of the ICA by clipping the common carotid artery, the proximal external carotid artery, and intracranial ICA distal to the aneurysm allowed to remove the remaining blood through the catheter. The aneurysm collapsed, and a clip could be easily placed over the neck of the aneurysm. Temporary clips were removed and blood flow controlled by micro-Doppler in all vessels. Somatosensory and motor evoked potentials had shown no diminishment of amplitudes. Control angiography revealed a completely clipped aneurysm, and ophthalmologic symptoms showed rapidly decreasing anopia. The patient was discharged on day seven without any new neurological deficits.

Conclusions: We believe that the suction decompression device is a most helpful tool for the surgical treatment of giant aneurysms situated close to the cranial base. If endovascular approaches fail, this method enables a full control and safe surgical approach of the aneurysm. However, this type of lesions should be only treated by an experienced neurovascular team with endovascular and neurosurgical capacities.