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22.12.2016 | Original Article | Ausgabe 3/2017

Neurosurgical Review 3/2017

Application of actuator-driven pulsed water jet in aneurysmal subarachnoid hemorrhage surgery: its effectiveness for dissection around ruptured aneurysmal walls and subarachnoid clot removal

Zeitschrift:
Neurosurgical Review > Ausgabe 3/2017
Autoren:
Hidenori Endo, Toshiki Endo, Atsuhiro Nakagawa, Miki Fujimura, Teiji Tominaga
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s10143-016-0809-5) contains supplementary material, which is available to authorized users.

Abstract

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.

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Zusatzmaterial
Video 1
Case 7. Intraoperative video of a right middle cerebral artery aneurysm. With the use of the actuator-driven pulsed water jet (ADPJ) system, a thick subarachnoid hemorrhage was removed. Note that veins or small arteries were not damaged when the water jet directly hit these vessels. Middle cerebral arteries were observed. (MP4 16,297 kb)
Video 2
Case 4. Intraoperative video of a right middle cerebral artery aneurysm. As the aneurysm was identified, pulsed water jet traced the contours of the aneurysm. Following aneurysmal exposure with the aid of the actuator-driven pulsed water jet system, a permanent clip was safely applied. (MP4 14,000 kb)
Video 3
Case 10. Intraoperative video of an anterior communicating artery aneurysm approached through right frontotemporal craniotomy. During the use of the actuator-driven pulsed water jet system, premature rupture was encountered. Minor leakage occurred from a dome of the aneurysm embedded in the right frontal lobe. After exposure, a permanent clip was safely applied. (MP4 20,845 kb)
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