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Principles and Techniques of Surgical Management of Ruptured Cerebral Aneurysms

  • Won-Sang Cho
  • Dae Hee Han
Chapter
Part of the Stroke Revisited book series (STROREV)

Abstract

Endovascular intervention has become a major treatment modality for cerebral aneurysms since the advent of the detachable coil in 1990. It is currently recommended as the first choice of treatment for ruptured aneurysms. Nonetheless, surgical treatment is still a major modality, and the degree of difficulty is relatively higher in cases which cannot be effectively managed using endovascular interventions and are therefore referred to the surgical arm. When performing a surgery for a ruptured aneurysm, it is very important to adhere to general principles, such as brain relaxation, dissection, parent artery control, and clipping techniques, and to gain experience in a variety of situations to achieve favorable outcomes and decrease surgical complications. In addition, specific considerations vary according to the locations of the aneurysms. The representative locations of the aneurysms include the internal carotid artery (paraclinoid segment of internal carotid artery, posterior communicating artery, anterior choroidal artery, and bifurcation of the internal carotid artery), anterior cerebral artery (anterior communicating artery and distal segment), middle cerebral artery (proximal, distal and bifurcation segments), and posterior circulation (posterior cerebral artery, basilar bifurcation, basilar trunk, superior/anterior inferior/posterior inferior cerebellar artery, and vertebral artery). The aim of this study is to describe the general principles and specific surgical considerations to consider in aneurysms based on the authors’ experiences and reports in the literature.

References

  1. 1.
    Winn HR, Richardson AE, Jane J. The assessment of the natural history of single aneurysms that have ruptured. In: Hopkins LN, Long DM, editors. Clinical management of intracranial aneurysms. New York: Raven Press; 1982. p. 1–10.Google Scholar
  2. 2.
    Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg. 1966;25:321–68.CrossRefPubMedGoogle Scholar
  3. 3.
    Jane JA, Kassel NF, Torner JC, et al. The natural history of aneurysms and arteriovenous malformations. J Neurosurg. 1985;62:321–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Hijdra A, Vermeulen M, van Gijn J, et al. Rerupture of intracranial aneurysms: a clinicoanatomic study. J Neurosurg. 1987;67:29–33.CrossRefPubMedGoogle Scholar
  5. 5.
    Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke. 2001;32:1176–80.CrossRefPubMedGoogle Scholar
  6. 6.
    Cho WS, Kim JE, Park SQ, et al. Korean clinical practice guidelines for aneurysmal subarachnoid hemorrhage. J Kor Neurosurg Soc. 2018;61:127–66.CrossRefGoogle Scholar
  7. 7.
    Dott NM. Intracranial aneurysms cerebral arterio-radiography and surgical treatment. Edinb Med J. 1933;40:219–34.Google Scholar
  8. 8.
    Dandy WE. Intracranial aneurysm of the internal carotid artery cured by operation. Ann Surg. 1938;107:654–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Krayenbuhl HA, Yasargil MG, Flamm ES, et al. Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg. 1972;37:678–86.CrossRefPubMedGoogle Scholar
  10. 10.
    Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg. 1991;75:8–14.CrossRefPubMedGoogle Scholar
  11. 11.
    Molyneux A, Kerr R, Stratton I, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360:1267–74.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366:809–17.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2012;43:1711–37.CrossRefPubMedGoogle Scholar
  14. 14.
    Steiner T, Juvela S, Unterberg A, et al. European stroke organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35:93–112.CrossRefPubMedGoogle Scholar
  15. 15.
    Committee for guidelines for management of aneurysmal subarachnoid hemorrhage. Japanese society on surgery for cerebral stroke. Evidence-based guidelines for the management of aneurysmal subarachnoid hemorrhage. English edition. Neurol Med Chir (Tokyo). 2012;52:355–429.CrossRefGoogle Scholar
  16. 16.
    Cho WS, Kim JE, Kang HS, et al. Keyhole approach and neuroendoscopy for cerebral aneurysms. J Korean Neurosurg Soc. 2017;60:275–81.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cho WS, Kim JE, Kang HS, et al. Dual-channel endoscopic indocyanine green fluorescence angiography for clipping of cerebral aneurysms. World Neurosurg. 2017;100:316–24.CrossRefPubMedGoogle Scholar
  18. 18.
    Cho WS, Kim JE, Kim SH, et al. Endoscopic fluorescence angiography with indocyanine green: a preclinical study in the swine. J Korean Neurosurg Soc. 2015;58:513–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Macdonald RL, editor. Neurosurgical operative atlas. Vascular neurosurgery, 2nd edn. New York: Thieme; 2009.Google Scholar
  20. 20.
    Britz GW, et al. Surgical approaches to intracranial aneurysms. In: Winn HR, editor. Youmans and Winn neurological surgery, 7th edn. Philadelphia: Elsevier; 2017. p. 3289–97.Google Scholar
  21. 21.
    Lawton MT. Seven aneurysms: tenets and techniques for clipping. New York: Thieme; 2011.CrossRefGoogle Scholar
  22. 22.
    Jabbarli R, Pierscianek D, Wrede K, et al. Aneurysm remnant after clipping: the risks and consequences. J Neurosurg. 2016;125:1249–55.CrossRefPubMedGoogle Scholar
  23. 23.
    Thompson BG, Brown RD Jr, Amin-Hanjani S, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2368–400.CrossRefPubMedGoogle Scholar
  24. 24.
    Szentirmai O, Hong Y, Mascarenhas L, et al. Endoscopic endonasal clip ligation of cerebral aneurysms: an anatomical feasibility study and future directions. J Neurosurg. 2016;124:463–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2018

Authors and Affiliations

  1. 1.Department of NeurosurgerySeoul National University HospitalSeoulSouth Korea
  2. 2.Department of Neurosurgery, Cerebral and Cardiovascular Disease CenterNational Medical CenterSeoulSouth Korea

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