Outcome of Surgical Clipping of 40 Complex Basilar Aneurysms Using the Transcavernous Route

Krisht, Ali F.; Bikmaz, Kerem; Kadri, Paulo A S; Partington, Sharon

doi:10.1227/01.neu.0000310189.58528.cd

Cited by 2 publications

(3 citation statements)

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“…Increased morbidity and mortality, and worse clinical outcome was also reported after surgical clipping compared to endovascular coiling of a posterior circulation aneurysm [ 12 ]. These findings initiated the use of endovascular treatment for a basilar apex region aneurysm [ 13 ]. The fact that fewer neurosurgeons are performing microsurgical clipping of basilar apex aneurysm supports the trend for treating basilar artery aneurysms endovascularly rather than surgically [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The fact that fewer neurosurgeons are performing microsurgical clipping of basilar apex aneurysm supports the trend for treating basilar artery aneurysms endovascularly rather than surgically [ 14 ]. The safety of endovascular occlusion of BA aneurysms has been proven, although long-term sustainability and efficacy remain unclear [ 13 , 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…The prevention of any injury to the brainstem and its perforators is crucial [ 30 ]. Different approaches to BA aneurysms have been described including the pterional approach introduced by G. Yasargil [ 31 ], the subtemporal approach pioneered by C. Drake [ 32 ], as well as lateral supraorbital [ 33 ], orbitozygomatic [ 34 , 35 ], modified presigmoid [ 36 ], transpetrosal [ 37 ] or transzygomatic transcavernous approaches, [ 13 ] and many others [ 38 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms

et al. 2020

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Based on the relationship between the posterior clinoid process and the basilar artery (BA) apex it may be difficult to obtain proximal control of the BA using temporary clips. Endovascular BA temporary balloon occlusion (TBO) can reduce aneurysm sac pressure, facilitate dissection/clipping, and finally lower the risk of intraoperative rupture. We present our experience with TBO during aneurysm clipping of posterior circulation aneurysms within the setting of a hybrid operating room (hOR). We report one case each of a basilar tip, posterior cerebral artery, and superior cerebellar artery aneurysm that underwent surgical occlusion under TBO within an hOR. Surgical exposure of the BA was achieved with a pterional approach and selective anterior and posterior clinoidectomy. Intraoperative digital subtraction angiography (iDSA) was performed prior, during, and after aneurysm occlusion. Two patients presented with subarachnoid hemorrhage and one patient presented with an unruptured aneurysm. The intraluminal balloon was inserted through the femoral artery and inflated in the BA after craniotomy to allow further dissection of the parent vessel and branches needed for the preparation of the aneurysm neck. No complications during balloon inflation and aneurysm dissection occurred. Intraoperative aneurysm rupture prior to clipping did not occur. The duration of TBO varied between 9 and 11 min. Small neck aneurysm remnants were present in two cases (BA and PCA). Two patients recovered well with a GOS 5 after surgery and one patient died due to complications unrelated to surgery. Intraoperative TBO within the hOR is a feasible and safe procedure with no additional morbidity when using a standardized protocol and setting. No relevant side effects or intraoperative complications were present in this series. In addition, iDSA in an hOR facilitates the evaluation of the surgical result and 3D reconstructions provide documentation of potential aneurysm remnants for future follow-up.

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Section: Introductionmentioning

confidence: 99%