Operative Technique
A trapping-evacuation technique for giant carotid-ophthalmic segment aneurysm clipping in a hybrid operating theater

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Abstract

It is essential to collapse giant carotid-ophthalmic (OA) segment aneurysms for successful microsurgical clipping. We present a trapping-evacuation technique utilising hybrid operating theater capabilities to soften OA aneurysms. The patients were prepared for both microsurgical and endovascular procedures. After the majority of the aneurysm was exposed, a balloon was placed at the orifice of the aneurysm to fully block the blood flow. When the balloon was inflated, blood was evacuated from the aneurysm sac to eliminate the space occupying effect. Subsequently, the aneurysm neck was clearly exposed which greatly facilitated clip placement. A control angiogram was obtained prior to closing the wound to ensure complete aneurysm obliteration. After the establishment of a hybrid operating theater in our hospital, two aneurysms were successfully clipped using this technique. Although postoperative complications occurred in both patients, none of the events were related to the endovascular procedure or the trapping-evacuation technique. As a well-organized procedure designed for use in a hybrid operating theater, the current trapping-evacuation technique is an option for the surgical clipping of giant OA aneurysms.

Introduction

The clipping of giant carotid-opthalmic segment (OA) aneurysms is challenging and technically demanding [4], [6], [11], [13], [14]. The proximal location adjacent to the skull base and cavernous sinus, close relationship with the optic nerves and poor visualization of the aneurysm neck increase the difficulty of the operation. Originating from the development of skull base techniques, anterior clinoid process drilling and unroofing of the optic canal are well-established techniques for sufficiently exposing giant OA aneurysms [7], [9]. However, the techniques for proximal carotid artery control and aneurysm collapsing continue to evolve with aim to make the trapping-evacuation method more simple and efficient [1], [3], [8], [15], [16].

The authors utilized a modified trapping-evacuation procedure utilizing the capabilities of a hybrid operating suite to clip giant OA aneurysms. The established procedures, detailed protocols and initial results are presented in the current report.

Section snippets

Methods

The surgery protocols were approved by the hospital’s Ethics Committee. Patient consent forms were signed prior to the operation. The hybrid operating theater was equipped with an Artis Zeego III (Siemens, Munich, Germany) and its associated workstation and an OPMI Pentero Microscope (Carl Zeiss Surgical, Oberkochen, Germany) as well as other equipment common to typical operating rooms. Two giant OA aneurysms that were treated using this technique are described here to document the organization

Patient 1

A 47-year-old woman experienced deterioration in right side vision for 6 months prior to admission. The preoperative visual testing indicated blindness on the right side, whereas the left side remained normal. A 26.5 mm OA aneurysm was identified on the right side with a neck that measured 7 mm (Fig. 2A). The aneurysm was clipped in the hybrid operating theater using the techniques previously described. The patient was sent to the intensive care unit for postoperative recovery. During the surgery,

Discussion

The surgical treatment of giant OA aneurysms, which involves broad skull base techniques and vascular maneuvers, remains significantly challenging for most neurosurgeons [5], [11], [13]. Of the techniques required for the surgical clipping of these aneurysms, proximal artery control has been shown to be crucial for a safe and successful procedure [2], [11], [13].

The trapping-evacuation technique for the purpose of proximal control and aneurysm collapse was initially described by Batjer and

Conclusion

The current modified trapping-evacuation technique using our well-organized procedure in a hybrid operating theater is an option for the surgical clipping of giant OA aneurysms.

Conflicts of Interest/Disclosures

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

Acknowledgments

This work was financially supported by the Capital Development Funds of Medical Science with grant number 2011-1001-01. The authors would like to thank Miss Gai-Liang Li for her illustration in Figure 1.

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