Anterior choroidal aneurysm clipping

The choroidal artery is another important branch of the posterior carotid artery after the posterior communicating artery. 70% of the people have only one artery, and 30% have 2 to 3 or even 4. The choroidal artery divides the small branch to supply the optic tract, the diencephalon, and the cerebral peduncle before entering the choroid plexus of the temporal lobe. The choroidal aneurysm accounts for 2.1% of the intracranial aneurysms and 6.6% of the internal carotid aneurysms, often occurring in the distal horn of the internal choroidal artery. The top of the tumor may point to the outside, embedded in the temporal lobe or on the cerebellar margin, or connected to the inside of the optic tract, or to the posterior or posterior, or upward. Treating diseases: aneurysms Indication 1. The disease is mild after the aneurysm rupture. It belongs to Hunt and Hess grade I to III, and can be operated within 3 days. 2, after the aneurysm rupture, the condition is heavier, belonging to the IV ~ V grade, to be operated when the condition is stable or improved. 3. If a life-threatening intracranial hematoma occurs after an aneurysm rupture, surgery should be performed immediately. 4. Unruptured aneurysms accidentally discovered. Contraindications 1. The condition of the aneurysm is critical after rupture, and it is in a state of sudden death (Grade V). 2, after aneurysm rupture complicated by severe cerebral vasospasm and cerebral edema, surgery can be postponed. 3, the patient has serious systemic diseases, such as heart disease, diabetes, kidney disease, lung disease, etc., can not tolerate craniotomy. Preoperative preparation 1. Brain CT scan to observe the distribution of subarachnoid hemorrhage, with or without intracranial hematoma, hydrocephalus and brain swelling. 2, cerebral angiography, the best digital subtraction of whole brain angiography, to understand the size, shape, location of aneurysms, the extent and extent of cerebral vasospasm. Multiple aneurysms can sometimes be found in order to plan surgical approaches and procedures. 3. Perform a detailed physical examination to estimate the patient's ability to withstand surgery. 4, relieve the patient's fear of surgery, sedatives before the operation to prevent the patient from rupture of the aneurysm due to preoperative emotional stress. 5. Wash the scalp one day before the operation, shave the hair on the morning of the operation, wash and disinfect the scalp, and wrap it in a sterile towel. 6, prepare for blood transfusion, give antibiotics to prevent infection. Surgical procedure 1. The wing point approach. 2, reveal aneurysm The procedure for revealing the choroidal artery is similar to that of the posterior communicating aneurysm. Fully opening the lateral fissure is important for the presence of an aneurysm because its position is more posterior than the posterior communicating aneurysm. Special care should be taken when pulling the lobes, because the aneurysm top can be buried in the temporal lobes as it is facing outwards, and can be embedded in the frontal lobes when facing upwards. Unintentional traction can lead to rupture of the aneurysm. The posterior carotid artery is separated posteriorly, and the choroidal artery and aneurysm are searched for distally from the posterior communicating artery. Most tumors of the aneurysm point to the lateral or posterior aspect. Aneurysms often block the choroidal artery and narrow the neck with bipolar electrocoagulation to help display the arteries. Drake found that the choroidal aneurysm mostly points to the posterolateral aspect, while the choroidal artery originates from the posterior medial aspect of the internal carotid artery. There is an angle between the two, so the artery is not clamped when the aneurysm is clipped. 3, clipping aneurysm Select a suitable tumor clip and clamp the neck of the neck perpendicular to the internal carotid artery. The method of operation is similar to that of a treated aortic aneurysm. complication Misplacement of the choroidal artery can cause ischemia in the cerebral peduncle.

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