Surgical Clipping of Complex Basilar Apex Aneurysms: A Strategy for Successful Outcome Using the Pretemporal Transzygomatic Transcavernous Approach

Krisht, Ali F.; Kadri, Paulo A S

doi:10.1227/01.neu.0000156785.63530.4e

Cited by 64 publications

(68 citation statements)

References 47 publications

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“…This may be due to the greater durability of microsurgery compared with embolization. A previous study reported that clipping was successful in 95% of patients with complex basilar top aneurysms, with no evidence of residual aneurysms on follow-up angiography provided 14,15) . Radiological complete occlusion of basilar apex aneurysms in our series was relatively worse than previous report.…”

Section: Features Of Microsurgical Clippingmentioning

confidence: 96%

Analysis of Clinical and Radiological Outcomes in Microsurgical and Endovascular Treatment of Basilar Apex Aneurysms

Jin

Ahn

Kwun

et al. 2009

J Korean Neurosurg Soc

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Objective : We aimed to analyze clinical and radiological outcomes retrospectively in patients with basilar apex aneurysms treated by coiling or clipping. Methods : Outcomes of basilar bifurcation aneurysms were assessed retrospectively in 77 consecutive patients (61 women, 16 men), ranging in age from 25 to 79 years (mean, 53.7 years) from 1999 to 2007. Results : Forty-nine patients out of 77 patients (63.6%) presented with subarachnoid hemorrhages of the 49 patients treated with coiling, 27 (55.1%) showed complete occlusion of the aneurysm sac. Of these, 13 patients (26.5%) developed coil compaction on angiographic or MRI follow-up, with recoiling required in 9 patients (18.4%). Procedural complications of coiling were acute infarction in nine patients and the bleeding of the aneurysms in six patients. The remaining 28 patients underwent microsurgery: twenty-six of these (92.9%) with microsurgery followed up with conventional angiography. Complete occlusion of the aneurysm sac was achieved in 19 patients (73.1%). Operation-related complications of microsurgery were thalamoperforating artery injuries in three patients, retraction venous injury in two, postoperative epidural hemorrhage (EDH) in one, and transient partial or complete occulomotor palsy in 14 patients. Glasgow Outcome Scores (GOS) were 4 or 5 in 21 of 28 (75%) patients treated with microsurgery at discharge, and at 6 month follow-up, 20 of 28 (70.9%) maintained the same GOS. In comparison, GOS of four or 5 was observed in 36 of 49 (73.5%) patients treated with coiling at discharge and at 6 month follow-up, 33 of 49 patients (67.3%) maintained the GOS from discharge. Conclusion : Basilar top aneurysms were still challenging lesions based on our series. Endovascular or microsurgery endowed with its inborn risks and procedural complications for the treatment of basilar apex aneurysms individually. Microsurgery provided better outcome in some specific basilar apex aneurysms. For reaching the most favorable outcome, endovascular modality as well as microsurgery was inevitably considered for each specific basilar apex aneurysm.

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Section: Features Of Microsurgical Clippingmentioning

confidence: 96%

Analysis of Clinical and Radiological Outcomes in Microsurgical and Endovascular Treatment of Basilar Apex Aneurysms

Jin

Ahn

Kwun

et al. 2009

J Korean Neurosurg Soc

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“…Their higher morbidity has encouraged different surgical and endovascular approaches; nevertheless, treatment is still fraught with limitations, especially intraoperative and postoperative morbidity and, with endovascular methods, high rates of incomplete occlusion and late reopening 1,2,3,4,5,6,7,8,9,10 . Several series have reported the outcomes of patients undergoing surgical or endovascular treatment of basilar aneurysms 9,27 .…”

Section: Basilar Artery Aneurysms Account For Approximately 7%mentioning

confidence: 99%

Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

Pahl

Oliveira

Rotta

2017

Arq. Neuro-Psiquiatr.

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Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. Methods: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. Results: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Conclusion: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.

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“…In patients afflicted with any of the aforementioned aneurysms, intraoperative extra-or intradural removal of the ACP (anterior clinoidectomy) is an essential manoeuvre to expose the aneurysm neck in order to ensure safe clip placement. Likewise, treatment of some supraclinoid aneurysms, basilar artery aneurysms, giant pituitary adenomas, and cavernous sinus lesions also require an anterior clinoidectomy, which is an important step in an extended neurosurgical approach [1,3,12,14,23,24]. In cases of suprasellar meningiomas, recurrent growth is prevented by removal of the bony tumour origin, including the ACP; therefore, an anterior clinoidectomy is also used in the treatment of such patients.…”

Section: Introductionmentioning

confidence: 99%

The pneumatisation of anterior clinoid process is not associated with any predictors that might be recognised preoperatively

Szmuda

Słoniewski²,

Baczalska³

et al. 2013

Folia Morphol

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Surgical Clipping of Complex Basilar Apex Aneurysms: A Strategy for Successful Outcome Using the Pretemporal Transzygomatic Transcavernous Approach

Cited by 64 publications

References 47 publications

Analysis of Clinical and Radiological Outcomes in Microsurgical and Endovascular Treatment of Basilar Apex Aneurysms

Analysis of Clinical and Radiological Outcomes in Microsurgical and Endovascular Treatment of Basilar Apex Aneurysms

Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

The pneumatisation of anterior clinoid process is not associated with any predictors that might be recognised preoperatively

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