![]() The long-term outcome of the treatment was analyzed. All 15 patients were treated with COCW, except for the first patient, who was treated using a single strip of cotton. Here we report the technical details of this method and the long-term outcomes of patients receiving this procedure.įifteen of 1275 (1.5%) patients with a ruptured cerebral aneurysm who received treatment at the Saiseikai Kumamoto Hospital during the period from January 1, 1999, to December 31, 2016, had an IC-BLA. This method is reliable in preventing the clips from slipping off and the aneurysm walls from being damaged during clipping, and it enables more appropriate and safer clipping. We have been performing the clipping on crossed wrapping (COCW) method using 2 strips of cotton on patients with an internal carotid artery blood blister-like aneurysm (IC-BLA). This study may thus contribute to the debate on the optimal treatment strategy for BBA. Five patients with WFNS SAH score 4 or 5 achieved favorable outcomes.Įarly double bypass technique guided by MCABP measurement and combined with trapping (or rarely clipping) seems to be a safe method with excellent long-term outcomes in patients in PINC. There were 2 premature intraoperative ruptures, but no perioperative mortality, aneurysm recurrence, or rebleeding. ![]() Although angiographic vasospasms were not observed in our patients, two of them experienced cerebral infarction, attributable more to the mass effect and postoperative ICA thrombosis than to SAH-induced vasospasm. By contrast, only a minimal drop in MCABP following ICA clamping was detected in two cases, although their collaterals were slim/nonvisualized on imaging. No pulse pressure in the MCA after internal carotid artery (ICA) clamping was found in 3 patients, although their ACoA or PCoA were well visualized on preoperative angiograms. Seven patients presented with World Federation of Neurosurgical Societies (WFNS) subarachnoid hemorrhage (SAH) score 4 or 5. Intraoperative middle cerebral artery blood pressure (MCABP) measurement was used for selection of bypass procedure. Retrospective analysis of clinical, radiological, and surgical data in 9 patients treated between January 2009 and December 2015. To analyze of benefit of double bypass technique to surgical outcomes in patients with ruptured BBA in poor initial neurological condition (PINC). ![]() Some surgeons prefer clipping reconstruction while others favor primary bypass with trapping. ![]()
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