Transcavernous Approach for Microsurgical Clipping of Ruptured Right Superior Cerebellar Artery Aneurysm with Cadaveric Stepwise Video Illustration

Najera, Edinson; Muhsen, Baha’eddin A.; Borghei-Razavi, Hamid; Obrzut, Michal; Adada, Badih

doi:10.1055/s-0041-1727178

Cited by 3 publications

(3 citation statements)

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“…Nevertheless, in some situations (wide base, dysmorphic features) coiling is not feasible, thus their surgical management has its own distinctive complexity and requires careful planning. When ruptured, these dysmorphic aneurysms must be treated urgently either via endovascular surgery or intraoperative clipping [ 24 ]. Four segments of SCA can be recognized as follows:…”

Section: Basilar Arterymentioning

confidence: 99%

“…This is particularly evident in the posterior cranial fossa or craniovertebral junction, where reduced spatial compliance can pose challenges [ 14 , 52 ]. The effective management of these lesions, whether through surgical or endovascular interventions, heavily depends on a comprehensive understanding of the normal neurovascular anatomy of the posterior circulation [ 24 , 25 , 32 ]. Additionally, knowledge of the cisternal anatomy in the infratentorial region and its proximity to cranial nerves is crucial in surgical procedures, as these serve as corridors and landmarks for accessing specific segments of the vertebrobasilar system [ 20 , 25 , 48 , 50 ].…”

Section: Introductionmentioning

confidence: 99%

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Posterior vascular anatomy of the encephalon: a comprehensive review

Morales-Roccuzzo,

Sabahi,

Obrzut

et al. 2024

Surg Radiol Anat

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Purpose This article presents a comprehensive exploration of neurovascular anatomy of the encephalon, focusing specifically on the intricate network within the posterior circulation and the posterior fossa anatomy; enhancing understanding of its dynamics, essential for practitioners in neurosurgery and neurology areas. Method A profound literature review was conducted by searching the PubMed and Google Scholar databases using main keywords related to neurovascular anatomy. The selected literature was meticulously scrutinized. Throughout the screening of pertinent papers, further articles or book chapters were obtained through additional assessment of the reference lists. Furthermore, four formalin-fixed, color latex–injected cadaveric specimens preserved in 70% ethanol solution were dissected under surgical microscope (Leica Microsystems Inc, 1700 Leider Ln, Buffalo Grove, IL 60089, USA), using microneurosurgical as well as standard instruments, and a high-speed surgical drill (Stryker Instruments 1941 Stryker Way Portage, MI 49002, USA). Ulterior anatomical dissection was performed. Results Detailed examination of the basilar artery (BA), a common trunk formed by the union of the left and right vertebral arteries, denoted a tortuous course across the basilar sulcus. Emphasis is then placed on the Posterior Inferior Cerebellar Artery (PICA), Anterior Inferior Cerebellar Artery (AICA) and Superior Cerebellar Artery (SCA). Each artery’s complex course through the posterior fossa, its divisions, and potential stroke-related syndromes are explored in detail. The Posterior Cerebral Artery (PCA) is subsequently unveiled. The posterior fossa venous system is explained, categorizing its channels. A retrograde exploration traces the venous drainage back to the internal jugular vein, unraveling its pathways. Conclusion This work serves as a succinct yet comprehensive guide, offering fundamental insights into neurovascular anatomy within the encephalon’s posterior circulation. Intended for both novice physicians and seasoned neuroanatomists, the article aims to facilitate a more efficient clinical decision-making in neurosurgical and neurological practices.

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Section: Basilar Arterymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Posterior vascular anatomy of the encephalon: a comprehensive review

Morales-Roccuzzo,

Sabahi,

Obrzut

et al. 2024

Surg Radiol Anat

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“…Given the history of complete left eye blindness for 10 months; anterior clinoidectomy was not done as it will prolong the procedure and increase the risks of internal carotid artery injury. The orbitozygomatic approach is an important armamentarium for tumours in the cavernous sinus region [ 14 , 15 ]. The postoperative course was uneventful.…”

Section: Management Of the Second Recurrencementioning

confidence: 99%

En-plaque sphenoid wing grade II meningioma: Case report and review of literature

Muhsen

Aljariri

Hashem

et al. 2022

Annals of Medicine &Amp; Surgery

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Introduction and importance En-plaque-meningioma (EPM) is characterized by its flat growth along the bony contour. It accounts for 2–9% of all meningiomas. Very few grade II or III EPM cases were reported. Surgical resection of sphenoid wing EPM is especially challenging as the tumour tends to invade the cavernous sinus, and/or the orbit, and their neurovascular structures. Consequently, tumours in such locations have a higher rate of recurrence. We report the clinical course and management of a patient suffering a second recurrence of grade II EPM. The clinical course of grade II EPM, and the management of multiple recurrences of EPM are scarcely reported in the literature. Case presentation A 53-year-old male with a history of three previous surgeries for EPM presented with decreased vision in the right eye. Brain magnetic resonance imaging (MRI) showed progression of a sphenoid wing meningioma invading the left optic nerve, indicating a second recurrence of the tumour. Clinical discussion We reviewed the literature discussing the clinical course of grade II EPM, and cases suffering multiple recurrences. Only a few cases were found with varying clinical course and management. In our case, surgical intervention was necessary to save the patient's vision. A modified orbitozygomatic craniotomy was performed. A small residual tumour invading the cavernous sinus was left for treatment with stereotactic radiosurgery. Conclusion Sphenoid wing EPM is challenging pathology to manage, especially grade II tumours which are rarely encountered. Multimodality treatment with surgery and radiotherapy offers EPM patients the best chance of treatment.

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Navigating the Rare and Dangerous: Successful Clipping of a Superior Cerebellar Artery Aneurysm Against the Odds of Uncontrolled Hypertension

Toader,

Serban,

Covache-Busuioc

et al. 2024

JCM

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Background/Objectives: Superior cerebellar artery (SCA) aneurysms are exceedingly rare, posing unique diagnostic and management challenges due to their complex anatomical location within the posterior circulation. The proximity of the SCA to vital structures, such as the brainstem and cerebellum, along with the significant role of poorly controlled hypertension in aneurysm formation, further complicates treatment. This case aims to highlight the surgical approach and management strategies employed in treating a rare SCA aneurysm in a patient with longstanding hypertension. Methods: A 68-year-old female presented with an acute onset of severe headache, nausea, and vomiting, later confirmed to be due to a ruptured SCA aneurysm. The patient’s history of poorly controlled hypertension was identified as a major contributing factor to the aneurysm’s development and rupture. Due to the aneurysm’s wide-neck morphology and irregular shape, microsurgical clipping was selected as the treatment method. The occipito-parietal far-lateral approach was employed to gain optimal access to the aneurysm, minimizing the risk to adjacent neurovascular structures. Results: Microsurgical clipping successfully excluded the aneurysm while preserving the parent artery. The surgical approach enabled precise aneurysm isolation and ensured no postoperative neurological deficits. The patient recovered well, with no significant complications, and hypertension management was emphasized as a vital element of the patient’s long-term care. Conclusions: The surgical technique effectively achieved complete aneurysm exclusion with preservation of the parent artery and no associated neurological deficits. The patient’s recovery was uneventful, highlighting the efficacy of the approach. Long-term management of hypertension remains a critical component to prevent recurrence and ensure sustained outcomes.

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Transcavernous Approach for Microsurgical Clipping of Ruptured Right Superior Cerebellar Artery Aneurysm with Cadaveric Stepwise Video Illustration

Cited by 3 publications

References 0 publications

Posterior vascular anatomy of the encephalon: a comprehensive review

Posterior vascular anatomy of the encephalon: a comprehensive review

En-plaque sphenoid wing grade II meningioma: Case report and review of literature

Navigating the Rare and Dangerous: Successful Clipping of a Superior Cerebellar Artery Aneurysm Against the Odds of Uncontrolled Hypertension

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