Microsurgical Clipping of Low-Riding Basilar Bifurcation Aneurysm

Wainberg, Ricardo Chmelnitsky; Costa, Marcos Devanir Silva da; Marchiori, Maurício; Soder, Ricardo Bernardi; Filho, José Maria de Campos; Netto, Hugo Leonardo Doria; Neto, Eliseu Paglioli; Chaddad-Neto, Feres

doi:10.1016/j.wneu.2018.12.093

Cited by 4 publications

(2 citation statements)

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“…ese techniques increase the working areas of the OCW and COW. [3,7,13,16,17,21,34,38] In addition, a posterior clinoidectomy can be performed for low riding BAs where the aneurysm lies within the shadow of the clivus and posterior clinoid process. [7,17,30,38] ese techniques to increase exposure, however, come with risks of CSF fistulas, oculomotor and abducens nerve palsies, vascular injury, and intraoperative hemorrhage.…”

Section: Resultsmentioning

confidence: 99%

Keyhole clipping of a low-lying basilar apex aneurysm without posterior clinoidectomy utilizing endoscopic indocyanine green video angiography

Wong

2020

Surgical Neurology International

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Background: Basilar apex (BX) aneurysms are surgically challenging due to their anatomic location, need to traverse neurovascular structures, and proximity to multiple perforator arteries. Surgical approaches often require extensive bone resection and neurovascular manipulation. Visualization of low-lying BX aneurysms is typically obscured by the posterior clinoid and upper clivus and poses a unique challenge. Subtemporal or anterolateral approaches with a posterior clinoidectomy are often required to achieve adequate exposure, though these maneuvers can add invasiveness, risk, and morbidity to the procedure. Endoscopes and, more recently, fluoroscopic angiography capable endoscopes offer the possibility of providing improved visualization with less exposure allowing for minimally invasive clipping. Case Description: We present the case of a 42-year-old female with incidentally found 5 mm middle cerebral artery and 5 mm BX aneurysms. She underwent a minimally invasive supraorbital keyhole craniotomy for the clipping of both aneurysms. While the posterior clinoid obstructed the necessary visualization for the BX aneurysm, use of endoscopy and endoscopic fluoroscopic angiography allowed for safe and successful clipping without the need for a posterior clinoidectomy. Conclusion: This represents the first reported case of a BX aneurysm clipping through a minimally invasive keyhole craniotomy using endoscopic indocyanine green video angiography. Use of endoscopic indocyanine green angiography, combined with keyhole endoscopic approaches, allows for safe minimally invasive clipping of challenging posterior circulation aneurysms.

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Section: Resultsmentioning

confidence: 99%

Keyhole clipping of a low-lying basilar apex aneurysm without posterior clinoidectomy utilizing endoscopic indocyanine green video angiography

Wong

2020

Surgical Neurology International

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show abstract

“…

Complex skull base and microsurgical techniques remain relevant for the treatment of posterior circulation aneurysms in the endovascular era. [1][2][3][4][5][6] The "half trans-sylvian and half subtemporal approach" combines the advantages of the anterior view from the pterional approach 7 and lateral view from the subtemporal approach 8-10 with a reduced frequency and severity of oculomotor nerve palsy and less temporal lobe elevation. 11,12 We describe the case of a 63-year-old man who presented with a Hunt-Hess grade II subarachnoid hemorrhage.

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confidence: 99%