CN113796928A - Rotation type intranasal aneurysm presss from both sides pincers - Google Patents

Abstract

The utility model provides a rotation type intranasal aneurysm presss from both sides pincers, includes binding clip, claw beam and pincers handle, the binding clip includes the holding head, the pincers handle is including rotatory arch, the pincers handle only has a support post. The needle holding forceps adopt a pen type structure, occupy small space, are more suitable for a narrow environment for clamping a nasal endoscope, can rotate 360 degrees, can freely set the opening and closing degree of the forceps head, can be used for various different aneurysm operations, can finish the rotation of the forceps rod and the opening and closing of the forceps head by one hand, and can be used for operating equipment such as an endoscope and the like by the other hand of a doctor, thereby being convenient for the development of the nasal endoscope operations.

Description

Rotation type intranasal aneurysm presss from both sides pincers

Technical Field

The invention relates to a medical instrument, in particular to a rotary type nasal aneurysm clip used in a transnasal endoscopic surgery.

Background

Intracranial aneurysms are mostly abnormal bulges on the wall of an intracranial artery, are the first causes of subarachnoid hemorrhage, and are second only to cerebral thrombosis and hypertensive cerebral hemorrhage in cerebrovascular accidents, and are the third cause. The morbidity of Chinese people is about 3-4%. The mortality and disability rate of patients with ruptured arteriomas is very high.

Intracranial aneurysms can be treated by craniotomy and interventional embolization. Both methods have their advantages and disadvantages. In recent years, as a third surgical method for treating aneurysms, endonasal access has been used to provide a direct visual field to occlude aneurysms at specific sites (e.g., the internal carotid superior and superior), anterior communicating arteries, and vertebrobasilar arteries with as little damage as possible.

When intracranial aneurysms are occluded by a transnasal endoscopic clip, the clip is opened and placed nasally at the neck of the aneurysm using a suitable clip applier to complete the occlusion procedure. The existing aneurysm clip applier used by the nasal endoscope is basically a clip applier for craniotomy, the instrument is gun-shaped, and the rear end of the instrument is circular arc-shaped, so that the 8-shaped structure needs a larger operation space at the rear part, and is more suitable for open operation under a microscope. In summary, a transnasal endoscopic approach aneurysm clipping requires a novel aneurysm clip suitable for operation in the tubular narrow space of the nasal cavity.

In the prior art, some technologies like bite-cutting forceps, tumor-removing forceps and mucosa forceps mainly used for nasal endoscope minimally invasive surgery exist. However, the above-mentioned apparatus is usually a simple modification of the existing aneurysm clip, and does not change the holding manner of the existing clip body, and at the same time, because it is used for the operation of nasopharynx, and does not have the need of rotating the clip body of the apparatus, it can not satisfy the basic function of the intracranial aneurysm operation.

Disclosure of Invention

In order to solve the problems, the invention provides a rotary type transnasal aneurysm clip, when needed, the clip can be operated by one hand to carry out conventional operation actions such as clipping, the clip part can rotate 360 degrees, and a more appropriate operation angle is selected according to different positions of the aneurysm.

Conventional forceps are usually of the handle type, and fingers are inserted into a handle sleeve for operation. Although the holding is stable, all fingers are occupied, when the position needs to be changed, the surgical forceps need to be moved, and the holding manner occupies a large space. In brain surgery, especially in nasal endoscopic surgery, the operation space is small, the holding mode of the traditional forceps is not favorable for operation development, even interference occurs, and operation failure is caused.

Meanwhile, the aneurysm operation is complicated, multi-angle and multi-position transformation is often needed, and if the traditional mode is adopted, a large amount of operations will seriously increase the fatigue degree of hands of a doctor. The rotating device can be added on the forceps body, and the rotation of the operation forceps replaces the rotation of the doctor, so that the working strength of the doctor is reduced, and the adaptability of the operation forceps to aneurysms at different positions is improved.

The specific technical scheme is as follows:

the utility model provides a rotation type intranasal aneurysm presss from both sides pincers, includes binding clip, claw beam and pincers handle, the binding clip includes the holding head, the pincers handle is including rotatory arch, the pincers handle only has a support post.

Preferably, the forceps handle further comprises a thin rod, and the rotating protrusion is arranged on the thin rod.

Preferably, the thin rod is hollow, the rotary protrusion comprises an interface, and the interface is connected with the hollow part of the thin rod.

Preferably, the clamping head comprises a movable jaw plate and a fixed jaw plate.

Preferably, the movable jaw and the fixed jaw have opposite clamping surfaces.

Preferably, the clamping surface has a groove thereon.

Preferably, a clamping plate is respectively arranged on two sides of the supporting column.

Preferably, the surface of the splint is subjected to anti-slip treatment.

Preferably, a plate spring is provided between the support post and the clamp plate.

Preferably, the leaf spring is prestressed.

The needle holding forceps adopt a pen type structure, occupy small space, are more suitable for narrow environment of endoscopic clamping through nose, can rotate 360 degrees for the forceps rod, can freely set the opening and closing degree for the forceps head, can be used for various aneurysm operations, can finish the rotation of the forceps rod and the opening and closing of the forceps head by one hand, and can be used for operating equipment such as an endoscope and the like by the other hand of a doctor, thereby being convenient for the development of endoscopic nasal surgery.

Drawings

FIG. 1 is a schematic structural view of a preferred embodiment of the rotary transnasal aneurysm clip of the present invention;

figure 2 is an enlarged view of the portion of the rotating transnasal aneurysm clip jaw of figure 1.

And (3) selecting reference symbols:

1-a binding clip; 2-a clamp rod; 3-a forceps handle; 11-movable jaw plate; 12-static jaw plate; 21-rotary lug boss, 22-trapezoidal lug boss; 31-support columns; 32-clamping plate; 33-leaf spring.

Detailed Description

Reference will now be made in detail to embodiments of the present invention, examples of which are illustrated in the accompanying drawings, wherein like or similar reference numerals refer to the same or similar elements or elements having the same or similar function throughout. The embodiments described below with reference to the drawings are illustrative and intended to be illustrative of the invention and are not to be construed as limiting the invention.

The first embodiment is as follows:

a hospital adopts a novel nasal aneurysm clamp to carry out a cerebral aneurysm clamping operation. Referring to fig. 1, the rotary transnasal aneurysm clip comprises a clip head, a clip rod and a clip handle. The whole body is made of stainless steel or titanium alloy, the front part is a binding clip, and the binding clip is connected with a clamp handle for holding through a slender metal rod clamp rod. The forceps head comprises a clamping head for clamping the aneurysm clip, the clamping head adopts a dynamic-static combination mode, and the forceps head is shown in the attached figure 2 and comprises a movable jaw plate and a relatively static jaw plate. The movable jaw plate and the static jaw plate are basically arc-shaped and form a circular clamping part, so that the aneurysm clip can be conveniently clamped. The radius of the circular part formed by the movable jaw plate and the fixed jaw plate is about 10 mm. The inner sides of the movable jaw plate and the fixed jaw plate are subjected to anti-slip treatment by using flexible resin materials, and the opposite surfaces are provided with the mesh lines. The movable jaw plate is connected with the static jaw plate through a pin shaft. The tail part of the static jaw plate is fixedly connected to the hollow thin rod of the clamp rod. The diameter of the thin rod of the clamp rod is 2mm, the length of the thin rod is about 110mm, the rear portion of the thin rod is provided with a rotating protrusion, when the clamp rod is used, the clamp rod can rotate 360 degrees in an all-around mode through the rotating protrusion, the clamp head is further driven to rotate, and objects to be clamped can be better aligned. The rotary lug is hollow with a standard luer fitting, the interior of which is hollow and coupled to the interior of the wand. The interface is connected with external fluid source, and when needs, fluid in the external fluid source gets into the pin through rotatory bellied interface to from the fluid mouth outflow on the binding clip, play the effect of clearance, washing, better improvement operation field of vision. In this embodiment, the fluid port is disposed at the position of the movable jaw and the stationary jaw and is substantially disposed on the stationary jaw, which does not affect the movement of the clamp head, but ensures that the fluid can flow out without obstruction.

The forceps handle is the main operating part and only has one basically cylindrical supporting column to form a pen-shaped structure. The clamping lever is connected to the support post at a distance from it by a trapezoidal boss. And two clamping plates are arranged on two sides of the support column respectively, a plate spring is arranged between the clamping plates and the support column and used for resetting the clamping plates, and the force of 300n is preset in the plate spring to keep the relative position between the movable jaw plate and the fixed jaw plate. The clamping plate is connected with a movable jaw plate of the clamping head of the binding clip through a metal wire, and when the clamping plate is pressed, the movable jaw plate moves to enable the binding clip to perform clamping action. All operations can be done with one hand. In order to ensure the reliability of the action, the surface of the splint is provided with a plastic layer for rough anti-skid treatment.

Example two:

a hospital performs a minimally invasive cerebral aneurysm clipping operation under neuroendoscopy. The operation visual field is very small, the wrist force of a doctor is very large in the traditional linear operation forceps, the doctor operates the traditional linear operation forceps for several hours, the traditional linear operation forceps often move and deform, and the operation effect is influenced. Meanwhile, the linear surgical forceps can block the visual field of the doctor and the operation position, and the accuracy of the action is influenced. Therefore, the novel nasal aneurysm forceps are improved on the basis of the original nasal aneurysm forceps, and the axis of the forceps rod and the axis of the forceps handle form a certain angle. In this embodiment, at a downward sloping angle of 15 °.

In practical application, the trapezoidal boss can be movably arranged, the angle change between the axis of the forceps rod and the axis of the forceps handle is realized by adjusting the trapezoidal boss, and the angle can be set between 20 degrees and-20 degrees.

Example three:

in a teaching case, the head needs to be operated through the nose. At this time, the parasubtotal cavernous sinus segment and the bed process segment ICA are ideal sites for establishing proximal control.

Parabed aneurysms are located in important neurovascular structures and are one of the most challenging vascular lesions that neurosurgeons may encounter. Due to the unique anatomy of this region, surgery was performed into the origin of the ophthalmic artery (OphA), the superior pituitary artery (SHA), the carotid fossa. Craniotomy procedures for treating paravertebral aneurysms result in complications and a higher residual/recurrence rate of the aneurysm than those in other sites due to technical difficulties. Perhaps this is the primary reason for the relative prevalence of interventional techniques in the treatment of these difficult conditions. However, in contrast to interventional techniques, clipping remains a popular option due to its durability and effectiveness.

Clamp-on extramural ICA has a risk of injury to trigeminal and abductional nerves, while clamp-on bed processes have a risk of injury to oculomotor nerves. The OphA onset is located within 4mm of the medial carotid artery on the line connecting the medial crypt and the medial apex of the lateral crypt in the nodule. The ICA on the bed has an average length of 7.2mm and can be safely clamped for remote control. Evaluation showed that a small aneurysm protruding above or inside was a favorable subject for endoscopic clamping (hereinafter EEA). However, the operation is multiple, the operation time is long, and the requirement on the operation precision is higher.

Meanwhile, endoscopic nasal access (EEAs) has become increasingly popular for treating various lesions on the basis of the skull. However, parabed ICA is anatomically closely located to the midline structure, and therefore, there is an important question as to whether EEA is suitable for treating parabed aneurysms. There have been some case reports, review articles and anatomical studies on the treatment of parabed aneurysms by EEA. However, skull base surgeons are reluctant to use EEA to treat intracranial aneurysms for a variety of reasons. First, in contrast to other diseases (e.g., tumors), aneurysm surgery requires maximum control of multiple factors, such as proximal and distal vascular control, control of the pericervical region of the aneurysm, protection of the perforator vessels, etc.; therefore, the experience and team cooperation required for endoscopic aneurysm surgery should be as high as possible, which is not available in many centers. Furthermore, to date, there are no surgical instruments dedicated to EEA, rendering EEA procedures time consuming and laborious.

In performing EEA surgery, a tailored epidural incision is first made to minimize the risk of neurovascular injury, including the starting point of injury OphA. The incision is substantially similar to the incision that reveals the portion of the optic nerve within the optic nerve tube. The dural incision begins at the lateral tuberosity recess (located at the superior-medial corner of the dural "skylight" incision that is used to control the bed processes segment ICA). After passing through the paranasal sinus of Shanghai, the incision was directed medially toward the medial tuberosity recess. After reaching the midline, the incision continues towards the sphenoid plane. After passing through the anterior portion between the sickle ligaments, which are the reflexes of the dura mater, the incision turns laterally and continues parallel to the anterior portion of the optic nerve tube, extending from the base of the anterior bed processes to the saddle tubercle, overlying the proximal portion of the optic nerve before entering the optic nerve tube, and turning back downward into the optic nerve tube. The prepared dura mater flap is then turned downwards to expose the suprasadular supratalar periapophysis region.

By adopting the clamp disclosed by the invention, the clamp handle is held by a single hand, and the clamp head enters the operation visual field through the clamp rod. The start of the superior bedded segments ICA and OphA and the walk before entry are identified. The starting point spatial coordinates of OphA were recorded. The distance between the starting point and the reference point is mathematically calculated. Next, the feasibility of pinching off the ICA at the distal end closest to the OphA starting point was evaluated. Various aneurysm clips were tested to find the optimal aneurysm clip shape. The critical procedure for safe placement of the aneurysm clip with the remaining perforator was recorded. In this process, the surgical field is important for the selection of the aneurysm clip. Any minor movement of the forceps heads may cause significant trauma to the subject. The opening and closing degree of the jaw plate is quantitatively changed by using the rotary protrusion, so that the action amplitude of a doctor in the operation process can be effectively controlled. It is noted that "safe" procedures in this context are those that do not cause significant damage to adjacent neural or vascular structures. In addition, the maximum possible clipping length of the superior bedded segment ICA was measured at the ICA's appearance point using the recorded spatial coordinates of the aneurysm clip placement point and DDR.

The rotary bulge on the rotary clamp rod is used for adjusting the posture of the clamp head, so that all sphenoidal sinus specimens are well gasified. Using the technique, all specimens were safely exposed to the paraslope, bed-process and suprabed segments, as well as the OphA. The distance between points and the sum of the OphA origin and point distances are guaranteed to be nearly equal (< 2mm difference), meaning that the OphA origin is at or near the line of the optic ganglion (the line passing through the midpoint of the saddle nodule crypt and the inside vertex of the outside crypt of the carotid artery (LOCR) of the optic nerve. the OphA origin is very close to the point of the inside carotid artery (within 4 mm).

The ramp side segment ICA is an ideal point for the near end control ICA. In order to place the aneurysm clip, bone must be abraded from its medial, anterior and lateral surfaces. The lateral abrasion includes a portion of the bone (i.e., the sphenoid uvula recess (26)) of the quadrilateral area outside the paraslope ICA. In this case, the requirement for the surgical field is high, and the stress on the operation object is large. At the moment, the clamp provided by the invention is held by one hand, and the other hand adjusts the operation object, so that the relative position between the two is ensured. A straight aneurysm clip is the best choice for proximal control here. By extensive abrasion of the sphenoid uvula recess, the outer lobes of the aneurysm clip may reach the makel cavity during use. To avoid damaging the abducted nerve when the paraspinal ICA and superior aneurysm clip are exposed, the abrasion should be no higher than the level of the maxillary nerve.

The bed processes ICA with an average length of 6.2. + -. 1.2 mm can reveal a range (5.0-8.4 mm) that facilitates the introduction of aneurysm clips. Control is proximal to the bed process segment ICA using a straight or curved (tip down) clamp. Here, the pituitary is inside the ICA, visible, and easily protected when going up the clip; care was taken to protect the oculomotor nerve (walking under PDR) while the lateral clip of the superior aneurysm clip.

Using a specific epidural incision, damage to the nerve and vascular structures of all specimens can be successfully avoided. Alternatively, the dural incision may begin from the midline below the upper sponge sinus.

All specimens, OphA, started on the superior bedded segment ICA. Of the 10 specimens, 8 specimens were from the upper inner face of ICA, and the remaining 2 specimens were from the upper face of ICA. In all specimens, a certain degree of optic nerve pull-up was required in order to better view the distal end of the superior cribrosa segment ICA. Using this method, the superior medial aspect of the superior bedded segment ICA can be observed in all specimens. However, the view outside the superior cribriform segment ICA is significantly limited, requiring a greater range of upward traction on the optic nerve. Using the four-handed technique, after a slight elevation of the optic nerve, the aneurysm clip can be above the superior segment of the bed process ICA. An ideal aneurysm clip to accomplish distal control is a right angle clip with the pointed end facing outwards. Importantly, dissection of the saddle diaphragm along the inside of the DDR increases the available space and increases the safety of passing the aneurysm clip through the distal ICA. This incision increases the mobility of the ICA and allows gentle manipulation of the pituitary for application of the aneurysm clip (fig. 2). The aneurysm clip can be safely placed distal to the start of the SHA, completing 5 out of 10 specimens. In the rest of the specimens, a short, non-redundant SHA prevented the aneurysm clip from safely passing through the ICA distal end to the start of the SHA. The mean length of the superior cribriform segment ICA suitable for distal control is 7.2. + -. 1.7 mm.

Distal control is necessary but very difficult in EEAs, especially when the aneurysm ruptures (12). Extensive exposure is often required, including extensive bone removal around the optic nerve tube and even simultaneous craniotomy exposure (12, 13). We were able to place a rectangular aneurysm clip at the distal ICA, either proximal or distal to the SHA origin (superior intrabed section ICA adapted to place the average clip length of 7.2 mm). In order to maximally reveal the space when the clip is attached, it is necessary to displace the ICA by opening the saddled diaphragm and create a space above the ICA by pulling upward the optic nerve. Despite these procedures, distal ICA safe upper aneurysm clips are challenging in all specimens because the tip of the clip is not easily visible outside of the ICA. This challenge may be even greater when the large aneurysm is directed medially or superiorly, blocking the view of the distal ICA. Furthermore, the walk-shape and origin of SHA may prevent effective upper aneurysm clip operation. A short, tight, non-redundant SHA with a start point near the OphA may not allow clips to be placed beyond the start point of the SHA. Unfortunately, because of the small SHA, this vessel is not grasped prior to surgery and can only be found after opening the dura. In general, when selecting a parabed aneurysm to be treated with EEA, the disadvantage of the second option for distal control should be considered, especially in case of large tumor volumes.

EEA is not a minimally invasive method of treating aneurysms. Some technical features of EEA leave many doubtful attitude towards the use of this method for treating aneurysms. Because the surgical path of EEA is deep and narrow, it is critical and difficult to master a skilled team. Furthermore, although the leakage rate of cerebrospinal fluid is significantly reduced after introduction of the septal mucosal valve, leakage of cerebrospinal fluid and meningitis may still cause significant problems after EEA.

Strict adherence to the principles of aneurysm surgery (e.g. effective proximal and distal control) is crucial in EEA. EEA is contraindicated if these principles cannot be followed in individual cases. Profound anatomical knowledge and detailed techniques are not necessarily trivial. The surgical team should be highly experienced in the treatment of aneurysms and the manipulation of EEAs, and should be skilled in the use of four-handed endoscopic techniques. The surgical team should also be experienced in dealing with extreme conditions, such as intra-operative aneurysm rupture. Aneurysm surgery should also design and manufacture special neurosurgical instruments.

Before deciding to perform EEA, the possibility of recurrence of the aneurysm should be considered. The risk of post-operative residue or recurrence of complex aneurysms is higher. It is reported that the second EEA is difficult because the surgeon has to deal with the adhesion of the aneurysm and aneurysm clip to adjacent structures, which is a high risk complication. Furthermore, it is extremely difficult to remove the EEA-placed aneurysm clip by craniotomy exposure if a second (craniotomy) procedure is necessary. Therefore, simple short-necked aneurysms with a low risk of recurrence may be more suitable for EEA.

Treatment of parabed aneurysms with EEA has certain risks and limitations, including difficulty in proximal and distal control, limited maneuverability of the parabed structures, and may require excessive nerve traction to separate the aneurysm neck, revealing the distal ICA. These results indicate that EEA may not be the optimal choice for most parabed aneurysms. However, partial parabed aneurysms may be suitable for EEA access, including small upwardly or inwardly directed aneurysms in the DDR 7.2mm range. Further clinical experience will help elucidate the actual role of EEA in the treatment of parabed aneurysms and its true risk and benefit.

Example four:

in the teaching practice in a hospital, the key parameters for feasibility assessment include "show the vessels and their respective perforator branches", "feasibility of obtaining proximal and distal control", and "feasibility of aneurysm clip placement", depending on the size, orientation and location of the aneurysm model. For convenience of teaching, we chose not to measure the size of the surgical field (including craniotomy and dural opening) and the surgical tunnel.

By using the aneurysm clip, the clamping angle of the jaw plate is adjusted by rotating the button, the aneurysm model is clamped, the proper clamping tightness is kept, and the aneurysm model is placed at the common part where an anterior communicating artery (ACoA) complex and a posterior circulation aneurysm form. Comprises basal artery tip (BA), posterior arteria cerebri (PCoA), posterior cerebral artery P1 segment (P1), Superior Cerebellar Artery (SCA), Anterior Inferior Cerebellar Artery (AICA), Vertebral Artery (VA), Posterior Inferior Cerebellar Artery (PICA), anterior arteria cerebri (ACoA), distal segment of anterior cerebral artery A1 (A1), and proximal segment of anterior cerebral artery A2 (A2). After the aneurysm model is placed in place, the rotary button is rotated to release the aneurysm model in a very small motion, so that the damage to the experimental body is avoided.

By obtaining control over the proximal and distal ends of the tumor-bearing vessel (using temporary aneurysm clips, Sugita Ti II standard and mini-aneurysm clips); then, evaluating the feasibility of placing the aneurysm clip on the neck of the aneurysm model; finally, the temporary aneurysm clip was removed to simulate the principle and procedure of microsurgical aneurysm clipping. Obtaining proximal and distal control is considered "safe and feasible" only if the perimeter of the blood vessel is fully contained within the jaws of the aneurysm clip, and the jaws of the aneurysm clip are fully visible during application of the aneurysm clip. An angled mirror is used to better show the aneurysm clip and to ensure protection of the perforator branches. The feasibility of adjusting the aneurysm clip at each step was also assessed. Also, in this operation, the aneurysm clip can be used to assist in indicating a specific location.

Two different sized and differently oriented aneurysm models are placed at each site and the same procedure is followed. The operative sinus of the instrument in each step was assessed and recorded as valid, neutral and invalid. For all key measurement parameters, 3 trials were performed, and then a decision was made based on the average measurement and recorded. In this case, it is convenient to control the jaw plates using a rotary knob. Because the action amplitude is very small, the aneurysm model at the adjacent position is hardly influenced.

Specimens revealing the perforator from the basilar, posterior communicating and P1 were 100%, 80% and 62%, respectively. Specimens required pituitary transposition with simultaneous abrasion of the saddle back and posterior bed processes for optimal exposure and control of BA 93.3% and PCoA, P1 and SCA 100%. Lateral extension of the descending slope approach requires access to both the supraand transcondylar aspect, not only providing better VA and PICA visualization, but also allowing the use of specialized instruments in both.

Proximal and/or distal control is better achieved in a miniaturized model of PCoA and P1. The size of the aneurysm model also affects the feasibility of the superior aneurysm clips at PCoA, P1, SCA and PICA. The orientation of the aneurysm model has an impact on the feasibility of the upper aneurysm clip at BA, PCoA, PICA and VA. The instrument is most operable in the aneurysm models of BA, P1, SCA and AICA.

All specimens revealed the anterior communicating arterial complex, but only 2 specimens (13.3%) could clamp the anterior communicating aneurysm model. Both clampable forms are pointing upwards. Neither distal aneurysm model was clamped at a 1. At the proximal end of A2, 50% of the exposed blood vessels can realize proximal and distal control, the clamping effect of the small model is better than that of the large model (16% and 5.3% respectively), and the total clamping rate is 10.6%. The clamping effect of the medial and ventral directed models was better at the proximal end of a2 than the lateral directed model (24%, 16% and 8% for the small models, respectively). Overall, the overall maneuverability of the instrument is poor, particularly at a1 and ACoA.

EEAs enter the ventral skull base through a direct pathway, requiring minimal manipulation of important neurovascular structures; thus, there is less risk of cranial nerve injury than with conventional transcranial approaches. Rod lens endoscopes provide enhanced illumination and better visualization of the surgical field, including anatomical regions (11, 14-16) that may not be visible to the microscope's straight line of sight. This is particularly important when clamping an aneurysm, as it protects the parent vessel and its small perforator branches and ensures that the aneurysm is completely excluded from circulation. The angle mirror provides the best visualization effect of the clamping piece in the process of clamping the upper aneurysm, and the risk of accidentally injuring other blood vessels, cranial nerves or brain stems into the clamping piece is reduced to the maximum extent. The panorama obtained by the endoscope compensates for the narrowing of the nasal passage. Furthermore, the basic principles of bimanual microsurgical techniques are applied in the implementation of EEA, which is crucial in solving the IAs problem.

Recent anatomical studies and clinical reports have highlighted methods of using EEA to clamp specific IAs located in the midline cranial base region. The 9 studies reported 21 complete endonasal pinches of 23 aneurysms (7 ruptured, 16 unbroken). 2 patients presented with 2 aneurysms. 14 aneurysms in the anterior circulation and 9 aneurysms in the posterior circulation. The parent vessels of the anterior circulating aneurysm include the ocular arteries (7), the superior pituitary artery (4), the anterior communicating artery (2), and the internal carotid artery (1) in the parabed segment. All the anterior circulating aneurysms (except the anterior communicating arteries) are directed medially. The posterior circulating aneurysms originate in the basal arterial apex (3 cases), the basal trunk (2 cases), the posterior cerebral artery (2 cases), VA (1 case), and PICA (1 case), respectively.

Two aneurysms were treated with interventional embolization in the first 1 patient in EEA, and transcranial clamp treatment after failure of intravascular stent placement in patient 2 (failure). Proximal and distal control were obtained via intranasal endoscopic access except for 1 case of aneurysms requiring a combination of wingtip craniotomy to obtain safe distal control. 20 aneurysms were successfully clamped, 3 were partially occluded, 2 required re-surgery and re-clamping, and 3 rd required interventional embolization. Intraoperative aneurysm rupture 1 example (26) was successfully treated by maintaining adequate field of view and readjusting the aneurysm clip. The most common postoperative complication was cerebrospinal fluid (CSF) leak (5, 23.8%) with successful repair in all patients, and stroke/infarction (5, 23.8%) due to transbronchial injury. Other neurological complications after surgery include meningitis (3 cases, 14.2%) and transient hemiplegia (1 case, 4.7%).

There are few anatomical studies on the feasibility of clamping IAs by EEA. All studies mainly evaluated the appearance of the vessels of interest and the feasibility of aneurysm clip placement; by using the clamp disclosed by the invention, the operation visual field is expanded, and the explanation in specific debridement is facilitated by single-hand operation. Meanwhile, the course effect is obviously changed after the use.

While embodiments of the invention have been shown and described, it will be understood by those of ordinary skill in the art that: various changes, modifications, substitutions and alterations can be made to the embodiments without departing from the principles and spirit of the invention, the scope of which is defined by the claims and their equivalents.

Claims (10)

1. The utility model provides a rotation type intranasal aneurysm presss from both sides pincers, includes binding clip, claw beam and pincers handle, its characterized in that: the binding clip comprises a clamping head, the binding clip handle comprises a rotary bulge, and the binding clip handle is provided with only one supporting column.

2. The rotary transnasal aneurysm clip of claim 1 wherein: the forceps handle further comprises a thin rod, and the rotating protrusion is arranged on the thin rod.

3. The rotary transnasal aneurysm clip of claim 1 or 2 wherein: the slender rod is hollow, the rotary protrusion comprises an interface, and the interface is connected with the hollow slender rod.

4. The rotary transnasal aneurysm clip of claim 3 wherein: the clamping head comprises a movable jaw plate and a fixed jaw plate.

5. The rotary transnasal aneurysm clip of claim 4 wherein: the movable jaw plate and the fixed jaw plate are provided with opposite clamping surfaces.

6. The rotary transnasal aneurysm clip of claim 5 wherein: the clamping surface is provided with a groove.

7. The rotary transnasal aneurysm clip of claim 4 wherein: and two sides of the supporting column are respectively provided with a clamping plate.

8. The rotary transnasal aneurysm clip of claim 7 wherein: and the surface of the splint is subjected to anti-skid treatment.

9. The rotary transnasal aneurysm clip of claim 8 wherein: and a plate spring is arranged between the supporting column and the clamping plate.

10. The rotary transnasal aneurysm clip of claim 9, wherein: the leaf spring is prestressed.

Images