Application of actuator-driven pulsed water jet in aneurysmal subarachnoid hemorrhage surgery: its effectiveness for dissection around ruptured aneurysmal walls and subarachnoid clot removal.
Application of actuator-driven pulsed water jet in aneurysmal subarachnoid hemorrhage surgery: its effectiveness for dissection around ruptured aneurysmal walls and subarachnoid clot removal.
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致动器驱动的脉冲水射流在动脉瘤性蛛网膜下腔出血手术中的应用：其对破裂的动脉瘤壁周围解剖和蛛网膜下腔血块清除的有效性。
DOI：
10.1007/s10143-016-0809-5
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Tominaga T.
中科院分区：
文献类型：
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作者：
Endo H;Endo T;Nakagawa A;Fujimura M;Tominaga T.
在动脉瘤性蛛网膜下腔出血（aSAH）的夹闭手术中，关键步骤包括去除血块和剥离动脉瘤，避免动脉瘤过早破裂或脑损伤。为了实现这一目标，本研究介绍了一种压电致动器驱动的脉冲水射流系统。本研究纳入42例aSAH患者，均行夹持手术。11例患者在ADPJ系统的辅助下接受手术（ADPJ组）。另外31例患者不使用ADPJ系统进行手术（对照组）。ADPJ系统用于血块清除和动脉瘤清扫。通过比较早破裂率、血栓清除程度和临床结果来判断ADPJ系统的临床影响。术中，ADPJ组和对照组分别有18.2%和25.8%的病例出现早破。虽然差异无统计学意义，但术中观察表明，ADPJ系统能够安全有效地清除血栓并剥离动脉瘤。计算机断层扫描显示实现了更高程度的血块清除，特别是当ADPJ系统用于术前血块体积大于25 ml的病例时（p= 0.047， Mann-Whitney U检验）。临床结果，包括术后脑损伤或症状性血管痉挛的发生率，两组相似。我们描述了使用ADPJ系统治疗aSAH的初步手术结果。虽然还需要进一步的研究，但ADPJ系统被认为是一种安全有效的血栓清除和动脉瘤解剖工具。
In clipping surgery for aneurysmal subarachnoid hemorrhage (aSAH), critical steps include clot removal and dissection of aneurysms without premature rupture or brain injuries. To pursue this goal, a piezo actuator-driven pulsed water jet (ADPJ) system was introduced in this study. This study included 42 patients, who suffered aSAH and underwent clipping surgery. Eleven patients underwent surgery with the assistance of the ADPJ system (ADPJ group). In the other 31 patients, surgery was performed without the ADPJ system (Control group). The ADPJ system was used for clot removal and aneurysmal dissection. The clinical impact of the ADPJ system was judged by comparing the rate of premature rupture, degree of clot removal, and clinical outcomes. Intraoperatively, a premature rupture was encountered in 18.2 and 25.8% of cases in the ADPJ and control groups, respectively. Although the differences were not statistically significant, intraoperative observation suggested that the ADPJ system was effective in clot removal and dissection of aneurysms in a safe manner. Computed tomography scans indicated the achievement of higher degrees of clot removal, especially when the ADPJ system was used for cases with preoperative clot volumes of more than 25 ml (p= 0.047, Mann–Whitney U test). Clinical outcomes, including incidence of postoperative brain injury or symptomatic vasospasm, were similar in both groups. We described our preliminary surgical results using the ADPJ system for aSAH. Although further study is needed, the ADPJ system was considered a safe and effective tool for clot removal and dissection of aneurysms.