Resultados da microcirurgia em 54 aneurismas intracranianos

Niemeyer, Paulo

doi:10.1590/S0004-282X1974000300001

Resumos

O autor apresenta sua experiência em 54 aneurismas arteriais intracranianos operados com técnica microcirúrgica, no período de janeiro de 1971 a março de 1974. Em 40 doentes classificados nos grupos I, II e III, não houve mortalidade. Incluindo 8 doentes do grupo IV, onde ocorreram 3 óbitos, a mortalidade foi de 6,2%. Nos doentes do grupo V, a mortalidade continua proibitiva, seja qual for a técnica usada. Os doentes foram operados com microscópio cirúrgico de fabricação brasileira, sendo usados clips de Yasargil, Scoville, Mayfield e de modelo do autor. Comparando os resultados atuais de microcirurgia (1971-1974), com a experiência anterior, baseada em cerca de 400 casos, no período de 1949 a 1970, o autor conclui que a cirurgia dos aneurismas com auxílio do microscópio é benigna e sem mortalidade nos doentes de bom risco cirúrgico. Considera a existência de espasmo o maior problema e julga que o momento mais oportuno de operar é quando surgem as melhoras clínicas, coincidindo com o desaparecimento do espasmo, entre o 7º e 10º dia, geralmente.

The experience in 54 intracranial arterial aneurysms operated on with microsurgical technique during the period of January 1971 to March 1974 is reported. In 40 patients classified in Groups I, II and III, there were no mortalities. Including 8 patients of Group IV with 3 deaths, the mortality rate was 6.2%. In the patients from Group V, the mortality rate continues to be prohibitive, regardless of the technique used. The patients were operated on with the surgical microscope made in Brasil, using clips of Yasargil, Scoville, Mayfield and some of the author's model. Comparing the present microsurgical results from 1971 to 1974 with the previous experience based on nearly 400 cases from the period of 1949 to 1970, the author concludes that the surgery of aneurysms with the help of the microscope is simple and without mortality in the patients of good surgical risk. He considers the existence of spasm as the greatest problem and judges that the best moment to operate is when clinical improvements appear, coinciding with the disappearance of the spasm, generally between the 7th and 10th days.

Resultados da microcirurgia em 54 aneurismas intracranianos

Microsurgery of intracranial aneurysms

Paulo Niemeyer

Clínica Neurocirúrgica, Casa de Saúde Dr. Eiras (Rio de Janeiro), com o auxílio do Conselho Nacional de Pesquisas: Chefe do Serviço

RESUMO

O autor apresenta sua experiência em 54 aneurismas arteriais intracranianos operados com técnica microcirúrgica, no período de janeiro de 1971 a março de 1974. Em 40 doentes classificados nos grupos I, II e III, não houve mortalidade. Incluindo 8 doentes do grupo IV, onde ocorreram 3 óbitos, a mortalidade foi de 6,2%. Nos doentes do grupo V, a mortalidade continua proibitiva, seja qual for a técnica usada. Os doentes foram operados com microscópio cirúrgico de fabricação brasileira, sendo usados clips de Yasargil, Scoville, Mayfield e de modelo do autor. Comparando os resultados atuais de microcirurgia (1971-1974), com a experiência anterior, baseada em cerca de 400 casos, no período de 1949 a 1970, o autor conclui que a cirurgia dos aneurismas com auxílio do microscópio é benigna e sem mortalidade nos doentes de bom risco cirúrgico. Considera a existência de espasmo o maior problema e julga que o momento mais oportuno de operar é quando surgem as melhoras clínicas, coincidindo com o desaparecimento do espasmo, entre o 7^o e 10^o dia, geralmente.

SUMMARY

The experience in 54 intracranial arterial aneurysms operated on with microsurgical technique during the period of January 1971 to March 1974 is reported. In 40 patients classified in Groups I, II and III, there were no mortalities. Including 8 patients of Group IV with 3 deaths, the mortality rate was 6.2%. In the patients from Group V, the mortality rate continues to be prohibitive, regardless of the technique used. The patients were operated on with the surgical microscope made in Brasil, using clips of Yasargil, Scoville, Mayfield and some of the author's model. Comparing the present microsurgical results from 1971 to 1974 with the previous experience based on nearly 400 cases from the period of 1949 to 1970, the author concludes that the surgery of aneurysms with the help of the microscope is simple and without mortality in the patients of good surgical risk. He considers the existence of spasm as the greatest problem and judges that the best moment to operate is when clinical improvements appear, coinciding with the disappearance of the spasm, generally between the 7th and 10th days.

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1. AKERMAN, A. & NIEMEYER, P. Hematoma cerebral espontâneo. Med. Cirurg. Farm. (Rio de Janeiro) 202/203:53, 1953.
2. AKERMAN, A. & NIEMEYER, P. Intracranial aneurysms syndromes. 5ş Congresso Internacional de Neurologia (Lisboa, 1953). Comunicações, Vol. 2:32.
3. CADEMARTORI, M. S.; FERREIRA, N. P.; WAINER, F. & WAGNER, R. Tratamento dos aneurismas do sistema da artéria cerebral anterior. Arq. Neuro-Psiquiat. (São Paulo) 32:24, 1974.
4. COPHIGNON, J.; REY, A.; THUREL, C. & HOUDART, R. Microchirurgie des anévrysmes artériels de la partie antérieure du polygone de Willis. Étude d'une serie consecutive de 48 cas. Neurochirurgie (Paris) 19:36, 1973.
5. DRAKE, C. G. On the surgical treatment of ruptured intracranial aneurysms Clin. Neurosurg. 13:122, 1966.
6. DRAKE, C. G. & ALLCOCK, J. M. Postoperative angiography and the "slipped" clip. J. Neurosurg. 39:683, 1973.
7. ECHLIN, F. A. Current concepts in the etiology and treatment of vasospasm. Clin. Neurosurg. 15:133, 1967.
8. FALEIRO, L. C. M.; RODRIGUES, P. A.; RODRIGUES, J. A.; CESARINI, I. M. & BONFIM, A. S. Tratamento microcirúrgico de aneurismas da artéria comunicante anterior. Arq. Neuro-Psiquiat. (São Paulo) 31:264, 1973.
9. FRENCH, L. A.; ZARLING, M. E. & SCHULTZ, E. A. Management of aneurysms of the anterior comunicanting artery. J. Neurosurg. 19:870, 1962.
10. FRENCH, L. A.; CHOU, S. N. & LONG, D. M. The direct approach to intracranial aneurysms. Clin. Neurosurg. 15:117, 1967.
11. HAMBY, W. B. Remarks concerning intracranial aneurysmal surgery. Clin. Neurosurg. 17:1, 1969.
12. HOLLIN, S. A. & DECKER, R. E. Effetiveness of microsurgery for intracranial aneurysms. Postoperative angiographic study of 50 cases. J. Neurosurg. 39:690, 1973.
13. HOOK, D. & NORLEN, G. Aneurysms of the middle cerebral artery. A report of 80 cases. Acta Chirurg. Scand. suppl. 235, 1958.
14. IWABUCHI, T. Cervical sympathectomy of cerebral angiospasm after aneurysm rupture. Neurol. Med. Chirurg. (Tóquio) 12:341, 1972.
15. INABA, Y.; FUKUSHIMA, Y.; TACHIBANA, N.; ITO, U.; KAMISASA, A.; KOMATSU, K.; FUJIMOTO, T.; TOMITA, S. & OHNO, K. Microneurosurgery in cerebral aneurysms. Neurol. Med. Chirurg. (Tóquio) 12:204, 1972.
16. JAMIESON, K. G. Direct operations for intracranial aneurysms: some technical problems and attempts at their solution. Neurol. Mec. Chirurg. 11:1, 1971.
17. JACOBSON, J. H. Development of Microsurgical Technique. Microvascular Surgery. Georg Thieme Verlag, Stuttgart, 1967, pág. 4.
18. KRAYENBUHL, H. A.; YASARGIL, M. G.; FLAMM, E. S. & TEW, J. M. JR. Microsurgical treatment of intracranial saccular aneurysms J. Neurosurg. 37:678, 1972.
19. LOUGHEED, W. M. Selection timing and technique of aneurysm surgery of the anterior circle of Willis. Clin. Neurosurg. 16:95, 1969.
20. MISUKAMI, M.; ARAKI, G. & MIHARA, H. Early operation of ruptured aneurysm with special reference to the postoperative arterial spasm. Neurol. Med. Chirurg. (Tóquio) 12:338, 1972.
21. NIEMEYER, P. Técnica da arteriografia experimental. Arch. Instituto Benjamin Baptista (Rio de Janeiro) 6:117, 1940.
22. NIEMEYER, P. & POMPEU, F. Die Vertebralis-Angiopraphie bei den Geschwülsten der hinteren Schädelgrube Archiv Psychiat Zeitsch. Neurol. 192: 220, 1954.
23. NIEMEYER, P. & BRITO CUNHA, J. L. Angiografia cerebral percutânea. J. Bras. Neurol. (Rio de Janeiro) 1:259, 1949.
24. NIEMEYER, P. & AKERMAN, A. Diagnóstico e tratamento cirúrgico dos aneurismas arteriovenosos do cérebro. Med. Cirurg. Farm. (Rio de Janeiro) 204:111, 1953.
25. NORLEN, G. & BARNAUM, A. S. Surgical treatment of aneurysms of the anterior communicating artery. J. Neurosurg. 10:634, 1953.
26. POMPEU, F. Angiografia cerebral e hemorragia subaracnoidea espontânea. Rev. Bras. Cirurg. 12:1017, 1949.
27. POOL, J. L. Timing and techniques in the surgery of ruptured aneurysms of the anterior communicating artery. J. Neurosurg. 19:378, 1962.
28. POUYANNE, H.; BANAYAN, A.; GUERIN, J. & RIEMENS, V. Les anévrysmes sacculaires multiples du système carotidien supra-clinoidien. Étude anatomo-clinique et therapeutique. Neuro-chirurgie (Paris) 19, supl. 1, 1973.
30. SAHS, A. L.; PERRET, G. E.; LOCKSLEY, H. B. & NISHIOKA, H. Intracranial Aneurysms and Subarachnoid Hemorrage. A Cooperative Study. J. B. Lipincott Co., Philadelphia, 1969.
31. SUZUKI, J.; YOSHIMOTO, T. & HORI, S. Continuous ventricular drainage to lessen surgical risk in ruptured intracranial aneurysm. Surg. Neurol. 2:87, 1974.
32. SUZUKI, S.; OHKUBO, T.; HIGUCHL H.; KURASHIMA, Y.; OTABE, K. & SUZUKI, J. Cerebral vasospasm by rupture of intracranial aneurysm. Neurol. Med. Chirurg. (Tóquio) 12:200, 1972.
33. THORALF, M. S.; ONOFRIO, B. M. & MERIDETH, J. Treatment of cerebral vasospasm from subarachnoid hemorrage with isoproterenol and lidocaine hy-drocloride. J. Neurosurg. 38:557, 1973.
34. YASARGIL, M. G. & CARTER, L. P. Saccular aneurysms of the distal anterior cerebral artery. J. Neurosurg. 40:218, 1974.
35. WILKINS, R H. Attemps at treatment of intracranial spasm in animals and human being. Surg. Neurol. 1:148, 1973.

Datas de Publicação

Publicação nesta coleção
12 Abr 2013
Data do Fascículo
Set 1974

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

[1] 1. AKERMAN, A. & NIEMEYER, P. Hematoma cerebral espontâneo. Med. Cirurg. Farm. (Rio de Janeiro) 202/203:53, 1953.

[2] 2. AKERMAN, A. & NIEMEYER, P. Intracranial aneurysms syndromes. 5ş Congresso Internacional de Neurologia (Lisboa, 1953). Comunicações, Vol. 2:32.

[3] 3. CADEMARTORI, M. S.; FERREIRA, N. P.; WAINER, F. & WAGNER, R. Tratamento dos aneurismas do sistema da artéria cerebral anterior. Arq. Neuro-Psiquiat. (São Paulo) 32:24, 1974.

[4] 4. COPHIGNON, J.; REY, A.; THUREL, C. & HOUDART, R. Microchirurgie des anévrysmes artériels de la partie antérieure du polygone de Willis. Étude d'une serie consecutive de 48 cas. Neurochirurgie (Paris) 19:36, 1973.

[5] 5. DRAKE, C. G. On the surgical treatment of ruptured intracranial aneurysms Clin. Neurosurg. 13:122, 1966.

[6] 6. DRAKE, C. G. & ALLCOCK, J. M. Postoperative angiography and the "slipped" clip. J. Neurosurg. 39:683, 1973.

[7] 7. ECHLIN, F. A. Current concepts in the etiology and treatment of vasospasm. Clin. Neurosurg. 15:133, 1967.

[8] 8. FALEIRO, L. C. M.; RODRIGUES, P. A.; RODRIGUES, J. A.; CESARINI, I. M. & BONFIM, A. S. Tratamento microcirúrgico de aneurismas da artéria comunicante anterior. Arq. Neuro-Psiquiat. (São Paulo) 31:264, 1973.

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

[10] 10. FRENCH, L. A.; CHOU, S. N. & LONG, D. M. The direct approach to intracranial aneurysms. Clin. Neurosurg. 15:117, 1967.

[11] 11. HAMBY, W. B. Remarks concerning intracranial aneurysmal surgery. Clin. Neurosurg. 17:1, 1969.

[12] 12. HOLLIN, S. A. & DECKER, R. E. Effetiveness of microsurgery for intracranial aneurysms. Postoperative angiographic study of 50 cases. J. Neurosurg. 39:690, 1973.

[13] 13. HOOK, D. & NORLEN, G. Aneurysms of the middle cerebral artery. A report of 80 cases. Acta Chirurg. Scand. suppl. 235, 1958.

[14] 14. IWABUCHI, T. Cervical sympathectomy of cerebral angiospasm after aneurysm rupture. Neurol. Med. Chirurg. (Tóquio) 12:341, 1972.

[15] 15. INABA, Y.; FUKUSHIMA, Y.; TACHIBANA, N.; ITO, U.; KAMISASA, A.; KOMATSU, K.; FUJIMOTO, T.; TOMITA, S. & OHNO, K. Microneurosurgery in cerebral aneurysms. Neurol. Med. Chirurg. (Tóquio) 12:204, 1972.

[16] 16. JAMIESON, K. G. Direct operations for intracranial aneurysms: some technical problems and attempts at their solution. Neurol. Mec. Chirurg. 11:1, 1971.

[17] 17. JACOBSON, J. H. Development of Microsurgical Technique. Microvascular Surgery. Georg Thieme Verlag, Stuttgart, 1967, pág. 4.

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

[19] 19. LOUGHEED, W. M. Selection timing and technique of aneurysm surgery of the anterior circle of Willis. Clin. Neurosurg. 16:95, 1969.

[20] 20. MISUKAMI, M.; ARAKI, G. & MIHARA, H. Early operation of ruptured aneurysm with special reference to the postoperative arterial spasm. Neurol. Med. Chirurg. (Tóquio) 12:338, 1972.

[21] 21. NIEMEYER, P. Técnica da arteriografia experimental. Arch. Instituto Benjamin Baptista (Rio de Janeiro) 6:117, 1940.

[22] 22. NIEMEYER, P. & POMPEU, F. Die Vertebralis-Angiopraphie bei den Geschwülsten der hinteren Schädelgrube Archiv Psychiat Zeitsch. Neurol. 192: 220, 1954.

[23] 23. NIEMEYER, P. & BRITO CUNHA, J. L. Angiografia cerebral percutânea. J. Bras. Neurol. (Rio de Janeiro) 1:259, 1949.

[24] 24. NIEMEYER, P. & AKERMAN, A. Diagnóstico e tratamento cirúrgico dos aneurismas arteriovenosos do cérebro. Med. Cirurg. Farm. (Rio de Janeiro) 204:111, 1953.

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

[26] 26. POMPEU, F. Angiografia cerebral e hemorragia subaracnoidea espontânea. Rev. Bras. Cirurg. 12:1017, 1949.

[27] 27. POOL, J. L. Timing and techniques in the surgery of ruptured aneurysms of the anterior communicating artery. J. Neurosurg. 19:378, 1962.

[28] 28. POUYANNE, H.; BANAYAN, A.; GUERIN, J. & RIEMENS, V. Les anévrysmes sacculaires multiples du système carotidien supra-clinoidien. Étude anatomo-clinique et therapeutique. Neuro-chirurgie (Paris) 19, supl. 1, 1973.

[29] 30. SAHS, A. L.; PERRET, G. E.; LOCKSLEY, H. B. & NISHIOKA, H. Intracranial Aneurysms and Subarachnoid Hemorrage. A Cooperative Study. J. B. Lipincott Co., Philadelphia, 1969.

[30] 31. SUZUKI, J.; YOSHIMOTO, T. & HORI, S. Continuous ventricular drainage to lessen surgical risk in ruptured intracranial aneurysm. Surg. Neurol. 2:87, 1974.

[31] 32. SUZUKI, S.; OHKUBO, T.; HIGUCHL H.; KURASHIMA, Y.; OTABE, K. & SUZUKI, J. Cerebral vasospasm by rupture of intracranial aneurysm. Neurol. Med. Chirurg. (Tóquio) 12:200, 1972.

[32] 33. THORALF, M. S.; ONOFRIO, B. M. & MERIDETH, J. Treatment of cerebral vasospasm from subarachnoid hemorrage with isoproterenol and lidocaine hy-drocloride. J. Neurosurg. 38:557, 1973.

[33] 34. YASARGIL, M. G. & CARTER, L. P. Saccular aneurysms of the distal anterior cerebral artery. J. Neurosurg. 40:218, 1974.

[34] 35. WILKINS, R H. Attemps at treatment of intracranial spasm in animals and human being. Surg. Neurol. 1:148, 1973.