Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 484-493
DOI: 10.4103/ajns.AJNS_69_20

Original Article

Institutional experience of microsurgical management in posterior circulation aneurysm

Raghavendra Sharma

Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh

,

Ambuj Kumar

¹Department of Neurosurgery, N.S.C.B. Medical College, Jabalpur, Madhya Pradesh

,

Yasuhiro Yamada

²Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya

,

Riki Tanaka

²Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya

,

Saurabh Sharma

³Department of Neurosurgery, Max Hospital, New Delhi

,

Kyosuke Miyatani

²Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya

,

Saeko Higashiguchi

²Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya

,

Tsukasa Kawase

²Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya

,

Srikanth Talluri

⁴Department of Neurosurgery, SVIMS, Tirupati, Andhra Pradesh

,

Yoko Kato

²Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya

› Institutsangaben

Introduction: Posterior circulation aneurysm constitutes 15%–20% of all intracerebral aneurysms. With the advancement of endovascular techniques, the microsurgery for posterior circulation aneurysms has been pushed back a little. Even the International Subarachnoid Aneurysmal Trial gave support to the concepts of endovascular procedures, but microsurgical modality should not be discouraged. We present our institutional experience of microsurgical techniques on posterior circulation aneurysms. Materials and Methods: We performed a retrospective analysis of 37 patients of posterior circulation aneurysm from 2015 to 2019, referred to Bantane Hospital, Japan. We included all posterior circulation aneurysms such as basilar tip, basilar trunk, and vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysms, admitted and treated with clipping or bypass and trapping. We assessed the outcome as measured by modified Rankin Score (mRS), complications, and mortality. Results: Out of 37 patients, 10 cases were a basilar tip, one case was the basilar trunk, and 26 cases were VA-PICA aneurysm. Intraoperatively, neuromonitoring, indocyanine green dye, dual-image videoangiography (DIVA), and neuro endoscope were used. Two patients of basilar tip aneurysm developed third cranial nerve paresis and six patients of VA-PICA aneurysm developed lower cranial nerve paresis which resolved spontaneously. All the patients were discharged with mRS of 0 or 1. No mortality was recorded in our study. Conclusion: Microsurgical clipping of posterior circulation aneurysm is safe in unruptured aneurysm with a very low risk of mortality and morbidity under experienced hands. All postoperative complications in our study were transient and resolved with time with no residual deficits. Preoperative simulation, intraoperative neuromonitoring, DIVA, and neuro endoscope help achieve complete obliteration of aneurysmal sac and avoid complications.

Key-words:

Key-words:

Basilar tip aneurysm - dual-image videoangiography - posterior circulation aneurysm - vertebral artery-posterior inferior cerebellar artery aneurysm

References
1 Ishibashi T, Murayama Y, Urashima M, Saguchi T, Ebara M, Arakawa H, et al. Unruptured intracranial aneurysms: Incidence of rupture and risk factors. Stroke 2009;40:313-6.
2 Schievink WI. Intracranial aneurysms. N Engl J Med 1997;336:28-40.
3 Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103-10.
4 Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised trial. Lancet 2002;360:1267-74.
5 Musara A, Yamada Y, Takizawa K, Seng LB, Kawase T, Miyatani K, et al. Anterior temporal approach and clipping of a high-riding basilar tip aneurysm: Case report and review of the surgical technique. Asian J Neurosurg 2019;14:1283-7.
6 Shiban E, Török E, Wostrack M, Meyer B, Lehmberg J. The far-lateral approach: Destruction of the condyle does not necessarily result in clinically evident craniovertebral junction instability. JNS 2016;125:196-201.
7 Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med 2006;355:928-39.
8 Pahl FH, Oliveira MF, Rotta JM. Microsurgical treatment of basilar tip aneurysms: Is it still acceptable? Arq Neuropsiquiatr 2017;75:697-702.
9 Kleinpeter G. Why are aneurysms of the posterior inferior cerebellar artery so unique? Clinical experience and review of the literature. Minim Invasive Neurosurg 2004;47:93-101.
10 Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: A systematic review. Stroke 1998;29:251-6.
11 de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid haemorrhage: A systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007;78:1365-72.
12 Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, et al. UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012;366:2474-82.
13 Raaymakers TW, Rinkel GJ, Limburg M, Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: A meta-analysis. Stroke 1998;29:1531-8.
14 Eftekhar B, Morgan MK. Preoperative factors affecting the outcome of unruptured posterior circulation aneurysm surgery. J Clin Neurosci 2011;18:85-9.
15 Hauck EF, White JA, Samson D. The small “surgical aneurysm” at the basilar apex. J Neurosurg 2010;112:1216-21.
16 Guglielmi G, Viñuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 1992;77:515-24.
17 Tateshima S, Murayama Y, Gobin YP, Duckwiler GR, Guglielmi G, Viñuela F. Endovascular treatment of basilar tip aneurysms using Guglielmi detachable coils: Anatomic and clinical outcomes in 73 patients from a single institution. Neurosurgery 2000;47:1332-9.
18 Birchall D, Khangure M, McAuliffe W, Apsimon H, Knuckey N. Endovascular treatment of posterior circulation aneurysms. Br J Neurosurg 2001;15:39-43.
19 Uda K, Murayama Y, Gobin YP, Duckwiler GR, Viñuela F. Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: Clinical experience with 41 aneurysms in 39 patients. J Neurosurg 2001;95:624-32.
20 Pandey AS, Koebbe C, Rosenwasser RH, Veznedaroglu E. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: Review of a 10-year experience. Neurosurgery 2007;60:626-36.
21 Cottier JP, Pasco A, Gallas S, Gabrillargues J, Cognard C, Drouineau J, et al. Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: A retrospective, multicenter study. AJNR Am J Neuroradiol 2001;22:345-51.
22 Nakov VS, Spiriev TY, Todorov IT, Simeonov P. Technical nuances of subtemporal approach for the treatment of basilar tip aneurysm. Surg Neurol Int 2017;8:15.
23 Darsaut TE, Fahed R, Macdonald RL, Arthur AS, Kalani MY, Arikan F, et al. Surgical or endovascular management of ruptured intracranial aneurysms: An agreement study. J Neurosurg 2018;131:25-31.
24 Peerless SJ, Drake CG. Posterior circulation aneurysms. In: Suzuki J, editor. Advances in Surgery for Cerebral Stroke. Tokyo: Springer Japan; 1988. p. 53-6.
25 Xiang J, Tutino VM, Snyder KV, Meng H. CFD: Computational fluid dynamics or confounding factor dissemination? The role of hemodynamics in intracranial aneurysm rupture risk assessment. AJNR Am J Neuroradiol 2014;35:1849-57.
26 Carl B, Bopp M, Chehab S, Bien S, Nimsky C. Preoperative 3-dimensional angiography data and intraoperative real-time vascular data integrated in microscope-based navigation by automatic patient registration applying intraoperative computed tomography. World Neurosurg 2018;113:e414-25.
27 Lehto H, Kivisaari R, Niemelä M, Dashti R, Elsharkawy A, Harati A, et al. Seventy aneurysms of the posterior inferior cerebellar artery: Anatomical features and value of computed tomography angiography in microneurosurgery. World Neurosurg 2014;82:1106-12.
28 Liew D, Ng PY, Ng I. Surgical management of ruptured and unruptured symptomatic posterior inferior cerebellar artery aneurysms. Br J Neurosurg 2004;18:608-12.
29 Izumo T, Matsuo T, Morofuji Y, Hiu T, Horie N, Hayashi K, et al. Microsurgical clipping for recurrent aneurysms after initial endovascular coil embolization. World Neurosurg 2015;83:211-8.
30 Peluso JP, van Rooij WJ, Sluzewski M, Beute GN. Coiling of basilar tip aneurysms: Results in 154 consecutive patients with emphasis on recurrent haemorrhage and re-treatment during mid- and long-term follow-up. J Neurol Neurosurg Psychiatry 2008;79:706-11.
31 Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Starke RM, et al. Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: A review of 235 cases. Neurosurgery 2012;71:785-94.
32 Lee KS, Shim JJ, Shim JH, Oh JS, Yoon SM. Cerebral aneurysms in judicial precedents. J Korean Neurosurg Soc 2018;61:474-7.
33 Richling B, Gruber A, Killer M, Bavinzski G. Treatment of ruptured saccular intracranial aneurysms by microsurgery and electrolytically detachable coils: Evaluation of outcome and long-term follow-up. Oper Tech Neurosurg 2000;3:282-99.
34 Mascitelli JR, Yaeger K, Wei D, Kellner CP, Oxley TJ, de Leacy RA, et al. Multimodality treatment of posterior inferior cerebellar artery aneurysms. World Neurosurg 2017;106:493-503.
35 Bohnstedt BN, Ziemba-Davis M, Edwards G, Brom J, Payner TD, Leipzig TJ, et al. Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: A comparison of endovascular and microsurgical clip ligation. World Neurosurg 2015;83:784-93.
36 Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Nakaji P, et al. Ten-year analysis of saccular aneurysms in the barrow ruptured aneurysm trial. J Neurosurg 2019;132:771-6.
37 Lai L, Morgan MK. Surgical management of posterior circulation aneurysms: defining the role of microsurgery in contemporary endovascular era. In Signorelli F, editor, Explicative cases of controversial issues in neurosurgery. Rijeka, Croatia: InTech. 2012. p. 235-256.