Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms: A Study of 52 Cases Over 10 Years

Tjahjadi, Mardjono; Jahromi, Behnam Rezai; Serrone, Joseph C.; Nurminen, Ville; Choque-Velasquez, Joham; Kivisaari, Riku; Lehto, Hanna; Niemelä, Mika; Hernesniemi, Juha

doi:10.1016/j.wneu.2017.09.014

Cited by 10 publications

(13 citation statements)

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“…[24,28] In some cases, the optimal surgical view may be achieved through intradural jugular tuberclectomy. [2,17,27]…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the major challenge in the surgery of PICA and VA aneurysms involve neurovascular structures that obscure the neck of the aneurysm rather than bony prominences. [27]…”

Section: Discussionmentioning

confidence: 99%

“…Our recent experience has shown that retrosigmoid craniotomy is an adequate approach to the small PICAprox and VAdist aneurysms that are consistent with other authors. [22,27,28] The benefits of the supine retrosigmoid craniotomy with contralateral head rotation include is the medial and upward gravity-facilitated traction of the cerebellum and brain stem from the base and VA elevation above the skull base. Due to the narrow surgery corridor, we do not use this approach in the large and fusiform aneurysms, especially when anastomosis may be required.…”

Section: Discussionmentioning

confidence: 99%

“…Tjahjadi et al . [27] recommend a standard retrosigmoid craniotomy (simple lateral suboccipital approach) for PICAprox aneurysms when the PICA-VA complex is 10 mm or more above the great occipital foramen. Otherwise, they recommend to make the craniotomy medial and down to the lateral part of the great occipital foramen.…”

Section: Discussionmentioning

confidence: 99%

“…[5,8,20] The most common presenting symptoms include subarachnoid and ventricular hemorrhage associated with a high risk of disability and death without surgical treatment. [20,22,27]…”

Section: Introductionmentioning

confidence: 99%

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Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Pilipenko¹,

Eliava²,

Okishev³

et al. 2019

Surgical Neurology International

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Background: The choice of surgical approaches and options for the microsurgical vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms repair remains controversial. Methods: A retrospective analysis of the clinical, surgical, and angiographic data of 80 patients with VA and PICA aneurysms treated from 2012 to 2018 was performed. Results: The aneurysms were saccular in 50 cases (62.5%) and fusiform in 30 cases (37.5%). The median suboccipital craniotomy was the most common approach (73.8%). Retrosigmoid craniotomy was performed in 25% of patients. There were the following types of microsurgical operations: neck clipping (61.25%), clipping with the artery lumen formation (13.75%), trapping (10%), proximal clipping (5%), and deconstruction with anastomosis (10%). Fifty-seven (71.3%) patients were discharged without worsening of the clinical signs after surgery. The most common postoperative neurological disorder was palsy of IX and X cranial nerve revealed in 14 (17.5%) patients. No fatal outcomes or patients in vegetative state were identified. The complete occlusion of PICA and VA aneurysms according angiography was in 77 (96.3%) cases. Conclusion: Microsurgical treatment is an effective method for VA and PICA aneurysms. The majority of VA and PICA aneurysms do not require complex basal approaches. A thorough preoperative planning, reconstructive clipping techniques, and anastomoses creation, as well as patient selection based on the established algorithms and consultations with endovascular surgeons, may reduce the number of complications and increase the rate of complete microsurgical occlusion in VA and PICA aneurysms.

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“…[24,28] In some cases, the optimal surgical view may be achieved through intradural jugular tuberclectomy. [2,17,27]…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the major challenge in the surgery of PICA and VA aneurysms involve neurovascular structures that obscure the neck of the aneurysm rather than bony prominences. [27]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[5,8,20] The most common presenting symptoms include subarachnoid and ventricular hemorrhage associated with a high risk of disability and death without surgical treatment. [20,22,27]…”

Section: Introductionmentioning

confidence: 99%

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