Tratamento dos aneurismas do sistema da artéria cerebral anterior

Cademartori, S.; Ferreira, Nelson Pires; Wainer, Felipe; Wagner, Roberto

doi:10.1590/S0004-282X1974000100003

Resumos

Os autores analisam a evolução do tratamento cirúrgico de aneurismas do sistema da artéria cerebral anterior no Instituto de Neurocirurgia de Porto Alegre, de 1960 a junho de 1972. Foram operados 63 pacientes, dos quais 41 por ataque direto. Consideram que o estudo angiográfico só deve ser feito em pacientes em condições clínicas satisfatórias ou estabilizadas. Descrevem pormenorisadamente a técnica cirúrgica preconisada em 1967 por um dos autores e o método de tratar tais aneurismas desde então. Apresentam quadros demonstrativos dos resultados obtidos em épocas sucessivas e os resultados globais alcançados. Acreditam que as técnicas atuais de tratamento serão favorecidas pela microcirurgia, mas uma via de acesso simples será sempre um fator favorável.

Sixty three cases of anterior cerebral artery aneurysms observed in the period of 1960-1972 were reviewed on basis of their surgical approaches. The authors claim the necessity to perform intracranial vessels arteriography only in alert patients, except when haematoma is to be suspected. The surgical procedure consists in a frontal triangular craniotomy, followed by a subfrontal approach to exposing the aneuysm. Superior posterior implan- tantion of the aneurysmal sac may require partial ablation of the girus retus. In the same way continuous cerebrospinal fluid drainage facilitates the approach, as the arterial hypotension enables a safer neck dissection. Only clippsing and wrapping techniques are now employed. The rate mortality was 50% between 1960 and 1967, 18% in the period 1967-72 and 16% in 19 cases operated in the last two years.

Tratamento dos aneurismas do sistema da artéria cerebral anterior

Surgical treatment of the anterior cerebral system aneurysms

Mário S. Cademartori^I; Nelson Pires Ferreira^I; Felipe Wainer^II; Roberto Wagner^II

^IInstituto de Neurocirurgia de Porto Alegre: Neurocirurgiões

^IIInstituto de Neurocirurgia de Porto Alegre: Médicos residentes

RESUMO

Os autores analisam a evolução do tratamento cirúrgico de aneurismas do sistema da artéria cerebral anterior no Instituto de Neurocirurgia de Porto Alegre, de 1960 a junho de 1972. Foram operados 63 pacientes, dos quais 41 por ataque direto. Consideram que o estudo angiográfico só deve ser feito em pacientes em condições clínicas satisfatórias ou estabilizadas. Descrevem pormenorisadamente a técnica cirúrgica preconisada em 1967 por um dos autores e o método de tratar tais aneurismas desde então. Apresentam quadros demonstrativos dos resultados obtidos em épocas sucessivas e os resultados globais alcançados. Acreditam que as técnicas atuais de tratamento serão favorecidas pela microcirurgia, mas uma via de acesso simples será sempre um fator favorável.

SUMMARY

Sixty three cases of anterior cerebral artery aneurysms observed in the period of 1960-1972 were reviewed on basis of their surgical approaches. The authors claim the necessity to perform intracranial vessels arteriography only in alert patients, except when haematoma is to be suspected. The surgical procedure consists in a frontal triangular craniotomy, followed by a subfrontal approach to exposing the aneuysm. Superior posterior implan- tantion of the aneurysmal sac may require partial ablation of the girus retus. In the same way continuous cerebrospinal fluid drainage facilitates the approach, as the arterial hypotension enables a safer neck dissection. Only clippsing and wrapping techniques are now employed. The rate mortality was 50% between 1960 and 1967, 18% in the period 1967-72 and 16% in 19 cases operated in the last two years.

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Instituto de Neurocirurgia Hospital São Francisco 90000 Porto Alegre, RS Brasil.

Trabalho do Instituto de Neurocirurgia de Porto Alegre, apresentado no IX Congresso Brasileiro de Neurocirurgia (Rio de Janeiro GB, 1972)

1. CADEMARTORI, M. S. Considerações clínicas e cirúrgicas sobre 115 casos de aneurismas intracranianos. Neurobiologia (Recife) 36:231, 1970.
2. COOK, A. W.; DONALD, M.; DOOLEY, D. M. & BROWDER, E. J. Anterior communicating aneurysms. Treatment by ligation of an anterior cerebral artery. J. Neurosurg. 23:371, 1965.
3. DRAKE, C. G.; BARR, H. W. K.; COLES, J. C. & GERGELY, N. F. The use of extracorporeal circulation and profound hypothermia in the treatment of ruptured intracranial aneurysms. J. Neurosurg. 21:575, 1964.
4. FRENCH, L. A.; ZARLING, M. E. & SCHULTZ, E. A. Management of aneurysms of the anterior communicating artery. J. Neurosurg. 19:870, 1962.
5. FRENCH, L. A.; SHELHY, N. C.; STORY, J. L. & SCHULTZ, E. Aneurysms of the anterior communicating artery. J. Neurosurg. 24:1057, 1966.
6. KEMPE, L. C. & VANDER ARK G. D. Classification of anterior communicating aneurysms as a basis of surgical approach. J. Neurosurg. 33:300, 1970.
7. KIRGIS, H. D.; FISHER, W. L.; LIEWELLYN, R. C. & Mc PEEBLES, C. E. Aneurysms of the anterior communicating artery and gross anomalies of the circle of Willis. J. Neurosurg. 25:73, 1966.
8. MASPES, P. E. & MARINI, G. Results of direct surgical treatment with special reference of the use of moderate hypothermia and circulatory arrest. J. Neurosurg. 21:284, 1964.
9. MEKISSOCK, 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.
10. MOUNT, L. A. Results of treatment of intracranial aneurysms using silvers- tone clamp. J. Neurosurg. 16:611, 1959.
11. NORLEN, G. & BARNAUM, A. S. Surgical treatment of aneurysms of the anterior communicating artery. J. Neurosurg. 10:634, 1953.
12. POOL, J. L. Timing and techniques in the intracranial surgery. J. Neurosurg. 19:378, 1962.
13. POOL, J. L. Bifrontal craniotomy for anterior communicating artery aneurysms. J. Neurosurg. 36:212, 1972.
14. SAHS, A. L. Hypotension and hypothermia in the treatment of intracranial aneurysms. J. Neurosurg. 25:593, 1966.
15. SKULTETY, F. M. & NISHIOKA, H. The result of intracranial surgery in the treatment of aneurysms. J. Neurosurg. 25:683, 1966.
16. SUGAR, O. & TSUCHIYA, G. Plastic coating of intracranial aneurysms with EDH-adesive. J. Neurosurg. 21:114, 1964.

Datas de Publicação

Publicação nesta coleção
16 Abr 2013
Data do Fascículo
Mar 1974

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

[1] 1. CADEMARTORI, M. S. Considerações clínicas e cirúrgicas sobre 115 casos de aneurismas intracranianos. Neurobiologia (Recife) 36:231, 1970.

[2] 2. COOK, A. W.; DONALD, M.; DOOLEY, D. M. & BROWDER, E. J. Anterior communicating aneurysms. Treatment by ligation of an anterior cerebral artery. J. Neurosurg. 23:371, 1965.

[3] 3. DRAKE, C. G.; BARR, H. W. K.; COLES, J. C. & GERGELY, N. F. The use of extracorporeal circulation and profound hypothermia in the treatment of ruptured intracranial aneurysms. J. Neurosurg. 21:575, 1964.

[4] 4. FRENCH, L. A.; ZARLING, M. E. & SCHULTZ, E. A. Management of aneurysms of the anterior communicating artery. J. Neurosurg. 19:870, 1962.

[5] 5. FRENCH, L. A.; SHELHY, N. C.; STORY, J. L. & SCHULTZ, E. Aneurysms of the anterior communicating artery. J. Neurosurg. 24:1057, 1966.

[6] 6. KEMPE, L. C. & VANDER ARK G. D. Classification of anterior communicating aneurysms as a basis of surgical approach. J. Neurosurg. 33:300, 1970.

[7] 7. KIRGIS, H. D.; FISHER, W. L.; LIEWELLYN, R. C. & Mc PEEBLES, C. E. Aneurysms of the anterior communicating artery and gross anomalies of the circle of Willis. J. Neurosurg. 25:73, 1966.

[8] 8. MASPES, P. E. & MARINI, G. Results of direct surgical treatment with special reference of the use of moderate hypothermia and circulatory arrest. J. Neurosurg. 21:284, 1964.

[9] 9. MEKISSOCK, 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.

[10] 10. MOUNT, L. A. Results of treatment of intracranial aneurysms using silvers- tone clamp. J. Neurosurg. 16:611, 1959.

[11] 11. NORLEN, G. & BARNAUM, A. S. Surgical treatment of aneurysms of the anterior communicating artery. J. Neurosurg. 10:634, 1953.

[12] 12. POOL, J. L. Timing and techniques in the intracranial surgery. J. Neurosurg. 19:378, 1962.

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

[14] 14. SAHS, A. L. Hypotension and hypothermia in the treatment of intracranial aneurysms. J. Neurosurg. 25:593, 1966.

[15] 15. SKULTETY, F. M. & NISHIOKA, H. The result of intracranial surgery in the treatment of aneurysms. J. Neurosurg. 25:683, 1966.

[16] 16. SUGAR, O. & TSUCHIYA, G. Plastic coating of intracranial aneurysms with EDH-adesive. J. Neurosurg. 21:114, 1964.