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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
A clinical study on the value of carotid cistern drainage during intracranial aneurysm clipping
Guo-Liang Jin1, Zi-Gang Yuan1, Yong-Zhi Zhou1
1Department of Neurosurgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang Province, China.
Insights
Carotid cistern drainage effectively manages subarachnoid hemorrhage after aneurysm clipping. This procedure helps control intracranial pressure and reduces complications like vasospasm and hydrocephalus in patients with ruptured intracranial aneurysms.
Area of Science:
- Neurosurgery
- Cerebrovascular Surgery
- Neurosurgical Techniques
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) poses significant risks, including cerebral vasospasm and hydrocephalus.
- Intracranial aneurysm clipping is a standard treatment for ruptured aneurysms.
- Effective management of subarachnoid blood and intracranial pressure is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of carotid cistern drainage during intracranial aneurysm clipping for aSAH.
- To assess the impact of this drainage technique on reducing complications.
Main Methods:
- A prospective study involving 6 patients with aSAH undergoing craniotomy for aneurysm clipping.
- Placement of a drainage tube in the carotid cistern post-clipping.
- Monitoring of cerebrospinal fluid (CSF) drainage volume and patient outcomes.
Main Results:
- Carotid cistern drainage was successfully implemented in all 6 patients.
- Postoperative drainage ranged from 130-290 ml of hemorrhagic CSF daily.
- No drainage-related complications were reported.
Conclusions:
- Carotid cistern drainage is a valuable adjunct in managing aSAH during aneurysm clipping.
- This technique effectively removes subarachnoid blood, mitigating risks of vasospasm and hydrocephalus.
- It aids in controlling intracranial hypertension following aneurysm surgery.
Introduction:
To investigate the value of carotid cistern drainage in patients with aneurysmal subarachnoid haemorrhage during intracranial aneurysm clipping.
Material And Methods:
Patients with ruptured intracranial aneurysms were included in this study. During the operation, the craniotomy was performed via a pterional approach to separate the Sylvian cistern and carotid cistern. After completing the clipping of the intracranial aneurysm, a drainage tube was placed in the carotid cistern between the ipsilateral internal carotid artery and optic nerve or lateral internal carotid artery, which was led out through the dura mater, cranial flap foramen or gap and scalp, and connected with an external drainage device.
Results:
A total of 6 patients with aneurysmal subarachnoid haemorrhage, who required craniotomy for clipping, were enrolled in the study. These patients were given carotid cistern drainage during the operation. Among these 6 patients, 2 had anterior communicating aneurysms, 1 had a posterior communicating aneurysm of the internal carotid artery, 2 had middle cerebral artery furcation aneurysms, and 1 patient had multiple intracranial aneurysms. For the Hunt-Hess score before the operation, 5 patients were in grade II and 1 patient was in grade III. Furthermore, the postoperative drainage was unobstructed, with a daily drainage of 130-290 ml of haemorrhagic cerebrospinal fluid (CSF).
Conclusions:
The CSF drainage of the carotid cistern applied in patients with aneurysmal subarachnoid haemorrhage during the craniotomy for clipping can effectively remove the subarachnoid haemorrhage, control the intracranial hypertension, and reduce the incidence of cerebral vasospasm and hydrocephalus.
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