suffered a sudden severe headache, accompanied by hemiplegia and symptoms of stroke. Upon investigation, it turned out to be a highly fatal ruptured brain aneurysm. At the critical moment, 3D printing, fluorescence imaging, electrophysiological monitoring, and various scientific and technological means were used. It took the neurosurgeon three hours to successfully defuse the intracranial "bomb" that was already bleeding.
The mortality rate after the "bomb" ruptured in the skull is extremely high
Ms. Zheng is 58 years old. She was admitted to the hospital due to cerebral infarction 5 years ago.
One morning, Ms. Zheng suddenly felt numbness and weakness in her right limb, accompanied by dizziness and headache. After resting for a while, the headache symptoms did not subside and instead developed into severe headaches. Considering the history of cerebral infarction, the family did not dare to ignore it, so they hurried to the emergency department of Guangdong Hydropower Hospital. After receiving the patient, the emergency department immediately opened the stroke green channel. After a cranial MR examination, it was found that the brain had cerebral infarction. Aneurysm can "explode" at any time, and the situation is very critical.
Local conditions were limited, so Guangdong Provincial Hydropower Hospital quickly found Zhang Yong, director of neurosurgery and chief physician of the Provincial No. 2 Hospital. Subsequently, Ms. Zheng was urgently transferred to the Neurosurgery Department of the Second Provincial Hospital. After arriving at the Second Provincial Hospital, another head CT scan found that Ms. Zheng's brain aneurysm had ruptured due to the strong impact of the blood flow. She had intracranial subarachnoid hemorrhage and the aneurysm was in the right side of the brain. At the bifurcation of the artery, the maximum diameter is up to 1.3cm.
Zhang Yong said: "Cerebral aneurysm is called a 'time bomb' buried in the brain by the medical community and is one of the most dangerous cerebrovascular diseases. Cerebral aneurysm is not a tumor, but an abnormal local expansion of the cerebral artery wall. To put it simply, a cerebral aneurysm is like a small balloon blown on the artery wall. The bulging cerebral artery wall is extremely thin and can rupture at any time. "
He added that after the cerebral aneurysm ruptures, blood can enter the brain parenchyma, causing. Subarachnoid hemorrhage, and a series of life-threatening complications . The mortality rate for the first hemorrhage is 30%, and if a second hemorrhage occurs, the mortality rate is as high as 70%.
Multiple technologies assisted in locating the aneurysm and successfully removed it
Ms. Zheng’s aneurysm showed cystic expansion and irregular shape. Considering the special size and growth pattern of the aneurysm, the first task is to clip/ embolize the aneurysm neck to reduce re-bleeding and ensure the patency of the parent trunk and branch arteries.
It has become a consensus that surgery should be done quickly. But how to choose the surgical method?
If endovascular interventional treatment is chosen, dense packing of the aneurysm with the assistance of a stent can reduce the risk of re-bleeding. However, due to the limitations of multiple important branch vessels, dense embolization is difficult, which means there is a higher risk of recurrence.
If you choose craniotomy , problems such as intraoperative bleeding, intracranial infection , and cerebral infarction will test the doctor's skills, requiring the surgeon to be proficient in various surgical approaches and hemostasis skills.
After comprehensive analysis, Director Zhang Yong’s team chose craniotomy and aneurysm clipping and vascular plastic reconstruction for large aneurysms with multi-branch blood vessels like Ms. Zheng’s.
In view of the complex structure of the patient's aneurysm, Director Zhang Yong fully evaluated the aneurysm structure using 3D printing technology before surgery, simulated the surgical approach and bone window shape, and repeatedly tried to select the appropriate aneurysm clip and simulated the surgical approach and artery. The operation of tumor clipping facilitates identification of anatomical structures during surgery and safe clipping, effectively protecting surgical blood vessels and brain tissue.
uses 3D printing technology to print out the patient’s skull and blood vessel shapes, providing a rehearsal opportunity for the surgery.
"At the same time, after previewing the 3D printed model, we can more accurately locate the brain aneurysm, and the craniotomy incision will be smaller, thereby reducing the risk of infection during postoperative skull repair." Zhang Yong said.
On the day of the operation, Ms. Zheng, under the monitoring of neuroelectrophysiology , exposed the aneurysm under the microscope based on the skull base position and blood vessel course of the 3D model. After a 3-hour battle, the aneurysm was successfully clipped and performed. Parent tumor vascular reconstruction treatment. Imaging review showed that the original aneurysm lesion was not visible and the important branch vessels were unobstructed. There were no postoperative sequelae and the patient was safely transferred out of the intensive care unit .
Zhang Yong said that the success of this "bomb disposal" surgery was thanks to the assistance of 3D printing technology, intraoperative fluorescence imaging and electrophysiological monitoring.
3D printing technology can simulate surgery before surgery, greatly improving safety. It has great reference value, especially for refractory multiple aneurysms and giant aneurysms. Intraoperative fluorescence imaging can effectively determine whether the aneurysm is completely clipped, avoid misclipping, and ensure the patency of the parent vessel. As for intraoperative electrophysiological monitoring, real-time monitoring of limb somatosensory evoked potentials can promptly reflect the patient's limb electrical stimulation activities, reduce intraoperative cerebral blood perfusion and reduce the occurrence of complications.
High blood pressure and other people need to be alert to three major warning signs
As one of the most dangerous cerebrovascular diseases, what kind of people are prone to aneurysms?
Zhang Yong said that aneurysms can occur in people of any age, and most of them are middle-aged people aged 40 to 60. However, it is worth noting that young patients with cerebral aneurysms are sometimes more difficult to treat than middle-aged and elderly patients. This is reflected in the sharp increase in intracranial pressure in a short period of time, and the death and disability rates caused by brain herniation are very common.
Zhang Yong reminded that there may be no symptoms before a cerebral aneurysm ruptures, but nearly half of patients have some warning signs before the aneurysm bleeds heavily.
first, explosive headache! Once an aneurysm ruptures, it can cause "the worst headache of your life." Any sudden, unbearable headache requires medical attention as soon as possible.
second, seizure . This is also an emergency caused by subarachnoid hemorrhage caused by a ruptured aneurysm, which generally manifests as a grand seizure of forced clonus of the limbs.
Thirdly, one side had drooping eyelids and double vision. This is caused by the aneurysm compressing the oculomotor nerve .
Zhang Yong emphasized that those over 40 years old, especially high-risk groups with hypertension, diabetes, atherosclerosis, family history of aneurysms, and polycystic kidney disease , should have a head CTA and head MR examination at least once a year. , understands the health status of cerebral blood vessels in a timely manner, and eliminates some high-risk lesions of cerebral blood vessels. If you find yourself suffering from intracranial aneurysm , it is best to consult an experienced specialist to assess the risk of bleeding and make a reasonable treatment choice.
Interview and writing: Nandu reporter Wang Daobin, intern, Ye Ying
correspondent, Zhu Jian
