Tratamento microcirúrgico de aneurismas da artéria comunicante anterior

Faleiro, Luiz Carlos Mendes; Rodrigues, Pedro Alcantara; Rodrigues, José Antonio; Cesarini, Itamar Megda; Bonfim, Antonio Sergio

doi:10.1590/S0004-282X1973000400003

Resumos

Os autores descrevem o tratamento microcirúrgico realizado em oito pacientes que tiveram hemorragia subaracnóidea espontânea por rotura de aneurisma da artéria comunicante anterior. A conduta clínica pré-operatória é apresentada sendo dada ênfase às condições do paciente antes do ato cirúrgico. A técnica cirúrgica é descrita em detalhe, sendo salientado o uso do microscópio binocular. Dos 8 pacientes, dois (25%) tinham mais de um aneurisma que foram tratados durante a mesma operação. A única complicação cirúrgica foi meningite pós-operatória em um paciente; esta complicação cedeu completamente ao tratamento. Após a operação 88% dos pacientes retornaram ao seu trabalho, não tendo havido óbito em virtude do tratamento.

The surgical treatment of eight patients who had spontaneous subarachnoid hemorrhage from ruptured anterior communicating aneurysms is reported. The pre-operatory treatment is described, with emphasis to the patients condition before surgery. The surgical technique is described with special reference to the use of binocular microscope. Two patients (25%) had multiple aneurysms which were treated at the same operation. Meningitis was a complication on one patient but subsided with antibiotic treatment. After the operation 88% of the patients returned to their primitive jobs and there was no death related to the surgical treatment. Comments on other procedures for the surgical treatment of anterior communicating aneurysms are made.

Tratamento microcirúrgico de aneurismas da artéria comunicante anterior

Microsurgical treatment of anterior communicating artery aneurysms

Luiz Carlos Mendes Faleiro^I; Pedro Alcantara Rodrigues^I; José Antonio Rodrigues^I; Itamar Megda Cesarini^II; Antonio Sergio Bonfim^III

^IProfessor Assistente de Clínica Neurológica, Neurocirurgião da Faculdade de Medicina da Universidade Federal de Minas Gerais e Neurocirurgião do Hospital Felicio Rocho

^IINeurocirurgião do Hospital Felício Rocho

^IIIResidente em Neurocirurgia. Hospital Felício Rocho

RESUMO

Os autores descrevem o tratamento microcirúrgico realizado em oito pacientes que tiveram hemorragia subaracnóidea espontânea por rotura de aneurisma da artéria comunicante anterior. A conduta clínica pré-operatória é apresentada sendo dada ênfase às condições do paciente antes do ato cirúrgico. A técnica cirúrgica é descrita em detalhe, sendo salientado o uso do microscópio binocular. Dos 8 pacientes, dois (25%) tinham mais de um aneurisma que foram tratados durante a mesma operação. A única complicação cirúrgica foi meningite pós-operatória em um paciente; esta complicação cedeu completamente ao tratamento. Após a operação 88% dos pacientes retornaram ao seu trabalho, não tendo havido óbito em virtude do tratamento.

SUMMARY

The surgical treatment of eight patients who had spontaneous subarachnoid hemorrhage from ruptured anterior communicating aneurysms is reported. The pre-operatory treatment is described, with emphasis to the patients condition before surgery. The surgical technique is described with special reference to the use of binocular microscope. Two patients (25%) had multiple aneurysms which were treated at the same operation. Meningitis was a complication on one patient but subsided with antibiotic treatment. After the operation 88% of the patients returned to their primitive jobs and there was no death related to the surgical treatment. Comments on other procedures for the surgical treatment of anterior communicating aneurysms are made.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Hospital Felício Rocho Av. do Contorno 9530 30000 Belo Horizonte, MG Brasil.

1. AHMED, R. H. & SEDZIMIR, C. B. Ruptured anterior communicating aneurysms. A comparison of medical and specific surgical treatment. J. Neurosurg. 26:213, 1967.
2. ALMEIDA, G. M.; TILBERY, C. P. & GAGLIARDI FERREIRA, L. C. Tratamento dos aneurismas intracranianos. Rev. Paul. Med. 77:193, 1971.
3. BONNAL, J. & STEVENAERT, A. Thrombosis of intracranial aneurysms of the circle of Willis after incomplete obliteration by clip or ligature across the neck. J. Neurosurg. 30:158, 1969.
4. DAVID, M.; PERTUIZET, B. & GUYOT, J. F. La cure radicale des anéurysmes de la communicant antérieure sans rÉsection cérébrale ni hypothermie dans le malade conscient. Présse Méd. 76:1467, 1968.
5. DRAKE, C. G. & VANDERLINDERS, R. G. The late consequences of incomplete surgical treatment of cerebral aneurysms. J. Neurosurg. 27:226, 1967.
6. DUTTON, J. Acrylic investment of intracranial aneurysms. A report of 12 years experience. J. Neurosurg. 31:652, 1969.
7. GRAF, C. J. Prognosis for patient with non surgically treated aneurysms. Analysis of the cooperative study of intracranial aneurysms and subarachnoid hemorhage. J. Neurosurg. 35:438, 1971.
8. HAMBY, W. Remarks Concerning Intracranial Aneurysmal Surgery. Proc. Congress of Neurological Surgeons. Williams a. Wilkins Co., Baltimore, 1970.
9. HUGENHOLTZ, H. & MORLEY, T. P. The results of proximal anterior cerebral artery oclusion for anterior communicating aneurysms. J. Neurosurg. 37:65, 1972.
10. HUNT, W. E.; MEAGHER, J. N. & BARNES, J. E. The management of intracranial aneurysms. J. Neurosurg. 19:34, 1962.
11. HUNT, W. E. & HESS, R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 28:14, 1968.
12. KEMPE, L. C. Operative Neurosurgery. Springer Verlag New York Inc., 1968.
13. KRAYENBÜHL, H. A.; YASARGIL, M. G.; FLAMM, E. S. & TEW, J. M. Microsurgical treatment of intracranial saccular aneurysms. J. Neurosurg. 37: 678, 1972.
14. Mc KISSOCK, W.; PAINE, K. W. E. & WALSH, L. S. An analysis of the results of treatment of ruptured intracranial aneurysms. Report of 772 consecutive cases. J. Neurosurg. 17:762, 1960.
15. Mc KISSOCK, W.; RICHARDSON, H. & WALSH, L. S. Anterior communicating aneurysms. A trial of conservative and surgical treatment. Lancet 1:873, 1965.
16. Mc MURTRY III, J. G.; POOL, J. L. & NOVA H. The use of Rheomacrodex in the surgery of intracranial aneurysms. J. Neurosurg. 26:218, 1967.
17. PAUL, R. L. & ARNOLD, J. G. Operative factors influencing mortality in intracranial aneurysms surgery. Analysis of 186 consecutive cases. J. Neurosurg. 32:280, 1970.
18. POOL, J. L. Bifrontal craniotomy for anterior communicating artery aneurysm. J. Neurosurg. 36:212, 1972.
19. RANSOHOFF, J.; GOODGOLD, H. & BENJAMIN, M. V. The operative management of patients with ruptured intracranial aneurysms. J. Neurosurg. 36:523, 1972.
20. SAHS, A. L.; PERRET, G. E.; LOCKSLEY, H. B. & NISHIOKA, H. Intracranial Aneurysms and Subarachnoid Hemorrhage. A Cooperative Study. J. B. Lippincott Co., Philadelphia, 1969.
21. SAMPAIO, P. Aneurismas da artéria comunicante anterior. Considerações sobre 14 casos operados. Arq. de Neuro-Psiquiat. (São Paulo) 28:367, 1970.
22. STEHBENS, W. E. Pathology of the Cerebral Blood Vessels. C. V. Mosby, Saint Louis, 1972.
23. TINDALL, G. T.; KAPP, J.; ADAM, G. L. & ROBINSON, S. C. A combined technique for treating certain aneurysms of the anterior communicating artery. J. Neurosurg. 33:41, 1970.
24. VANDER ARK, G. D. & KEMPE, L. C. Classification of anterior communicating aneuryms as a basis for surgical approach. J. Neurosurg. 32:300, 1970.
25. YASARGIL, M. G. Microsurgery Applied to Neurosurgery. Georg Thieme Verlag, Stuttgart, 1969.

Datas de Publicação

Publicação nesta coleção
15 Abr 2013
Data do Fascículo
Dez 1973

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AHMED, R. H. & SEDZIMIR, C. B. Ruptured anterior communicating aneurysms. A comparison of medical and specific surgical treatment. J. Neurosurg. 26:213, 1967.

[2] 2. ALMEIDA, G. M.; TILBERY, C. P. & GAGLIARDI FERREIRA, L. C. Tratamento dos aneurismas intracranianos. Rev. Paul. Med. 77:193, 1971.

[3] 3. BONNAL, J. & STEVENAERT, A. Thrombosis of intracranial aneurysms of the circle of Willis after incomplete obliteration by clip or ligature across the neck. J. Neurosurg. 30:158, 1969.

[4] 4. DAVID, M.; PERTUIZET, B. & GUYOT, J. F. La cure radicale des anéurysmes de la communicant antérieure sans rÉsection cérébrale ni hypothermie dans le malade conscient. Présse Méd. 76:1467, 1968.

[5] 5. DRAKE, C. G. & VANDERLINDERS, R. G. The late consequences of incomplete surgical treatment of cerebral aneurysms. J. Neurosurg. 27:226, 1967.

[6] 6. DUTTON, J. Acrylic investment of intracranial aneurysms. A report of 12 years experience. J. Neurosurg. 31:652, 1969.

[7] 7. GRAF, C. J. Prognosis for patient with non surgically treated aneurysms. Analysis of the cooperative study of intracranial aneurysms and subarachnoid hemorhage. J. Neurosurg. 35:438, 1971.

[8] 8. HAMBY, W. Remarks Concerning Intracranial Aneurysmal Surgery. Proc. Congress of Neurological Surgeons. Williams a. Wilkins Co., Baltimore, 1970.

[9] 9. HUGENHOLTZ, H. & MORLEY, T. P. The results of proximal anterior cerebral artery oclusion for anterior communicating aneurysms. J. Neurosurg. 37:65, 1972.

[10] 10. HUNT, W. E.; MEAGHER, J. N. & BARNES, J. E. The management of intracranial aneurysms. J. Neurosurg. 19:34, 1962.

[11] 11. HUNT, W. E. & HESS, R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 28:14, 1968.

[12] 12. KEMPE, L. C. Operative Neurosurgery. Springer Verlag New York Inc., 1968.

[13] 13. KRAYENBÜHL, H. A.; YASARGIL, M. G.; FLAMM, E. S. & TEW, J. M. Microsurgical treatment of intracranial saccular aneurysms. J. Neurosurg. 37: 678, 1972.

[14] 14. Mc KISSOCK, W.; PAINE, K. W. E. & WALSH, L. S. An analysis of the results of treatment of ruptured intracranial aneurysms. Report of 772 consecutive cases. J. Neurosurg. 17:762, 1960.

[15] 15. Mc KISSOCK, W.; RICHARDSON, H. & WALSH, L. S. Anterior communicating aneurysms. A trial of conservative and surgical treatment. Lancet 1:873, 1965.

[16] 16. Mc MURTRY III, J. G.; POOL, J. L. & NOVA H. The use of Rheomacrodex in the surgery of intracranial aneurysms. J. Neurosurg. 26:218, 1967.

[17] 17. PAUL, R. L. & ARNOLD, J. G. Operative factors influencing mortality in intracranial aneurysms surgery. Analysis of 186 consecutive cases. J. Neurosurg. 32:280, 1970.

[18] 18. POOL, J. L. Bifrontal craniotomy for anterior communicating artery aneurysm. J. Neurosurg. 36:212, 1972.

[19] 19. RANSOHOFF, J.; GOODGOLD, H. & BENJAMIN, M. V. The operative management of patients with ruptured intracranial aneurysms. J. Neurosurg. 36:523, 1972.

[20] 20. SAHS, A. L.; PERRET, G. E.; LOCKSLEY, H. B. & NISHIOKA, H. Intracranial Aneurysms and Subarachnoid Hemorrhage. A Cooperative Study. J. B. Lippincott Co., Philadelphia, 1969.

[21] 21. SAMPAIO, P. Aneurismas da artéria comunicante anterior. Considerações sobre 14 casos operados. Arq. de Neuro-Psiquiat. (São Paulo) 28:367, 1970.

[22] 22. STEHBENS, W. E. Pathology of the Cerebral Blood Vessels. C. V. Mosby, Saint Louis, 1972.

[23] 23. TINDALL, G. T.; KAPP, J.; ADAM, G. L. & ROBINSON, S. C. A combined technique for treating certain aneurysms of the anterior communicating artery. J. Neurosurg. 33:41, 1970.

[24] 24. VANDER ARK, G. D. & KEMPE, L. C. Classification of anterior communicating aneuryms as a basis for surgical approach. J. Neurosurg. 32:300, 1970.

[25] 25. YASARGIL, M. G. Microsurgery Applied to Neurosurgery. Georg Thieme Verlag, Stuttgart, 1969.