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

Pahl, Félix Hendrik; Oliveira, Matheus Fernandes de; Rotta, José Marcus

doi:10.1590/0004-282x20170120

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…[7,8] In our retrospective study, we found that 24.32% of patients had multiple aneurysms, which are collaborating with other studies. [7,8] The management of posterior circulation has been a tough task due to multiple issues in which proximity to the brain stem, multiple perforators to the brain stem, and eloquent areas of the brain are important ones. [9] Due to this complex anatomy, the margin of error is too narrow.…”

Section: Discussionsupporting

confidence: 90%

Institutional experience of microsurgical management in posterior circulation aneurysm

Sharma¹,

Kumar

Yamada

et al. 2020

Asian J Neurosurg

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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.

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Section: Discussionsupporting

confidence: 90%

Institutional experience of microsurgical management in posterior circulation aneurysm

Sharma¹,

Kumar

Yamada

et al. 2020

Asian J Neurosurg

View full text Add to dashboard Cite

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Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America

Marsool Marsool,

Bharadwaj,

Ali

et al. 2024

World Neurosurgery

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Multimodality techniques in microsurgical clipping as the gold standard treatment in the management of basilar tip aneurysm: A case series

et al. 2018

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Introduction:Basilar aneurysms represent 5%–7% of all intracranial aneurysms. The main goal of open surgery is to achieve complete obliteration of the aneurysmal sac using minimal invasive technique while emphasizing on avoidance of complication.Materials and Methods:We performed a retrospective cohort study of nine cases of unruptured basilar tip aneurysm referred to the Fujita Health University Banbuntane-Hotokukai Hospital, Japan. The objective of the study was to analyze the surgical outcomes of unruptured basilar tip aneurysm.Results:Nine patients with unruptured basilar tip aneurysm were referred to our hospital between 2015 and 2017. The median size of the aneurysm and age were 4.00 mm (interquartile range [IQR] = 3.25–6.75 mm) and 58 years (IQR = 54–70 years), respectively. Five patients (55.6%) were presented with multiple intracranial aneurysms. Surgical adjuncts such as intraoperative neuromonitoring, intraoperative indocyanine green (ICG) angiography with dual-image videoangiography (DIVA), and neuroendoscope were used. Two patients developed transient postoperative oculomotor nerve palsy which resolved spontaneously. The median duration of surgery and days of hospitalization were 292 min (IQR = 237.5–350.5 min) and 12 days (IQR = 12–25 days), respectively. There was no mortality recorded in this case series.Conclusion:Microsurgical clipping of basilar tip aneurysm is safe in unruptured basilar tip aneurysm with a low risk of postoperative mortality or morbidity. All complications reported in this case series were transient with no long-term sequalae. The improved safety profile of microsurgical technique is due to the availability of intraoperative neuromonitoring, neuroendoscope, ICG, and DIVA. The application of multimodality technique in neurovascular surgery has also helped to achieve complication avoidance. The obliteration of the aneurysmal sac helps to restore the laminar blood flow in the bifurcation and distal blood vessels and improves the brain perfusion.

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

Cited by 3 publications

References 24 publications

Institutional experience of microsurgical management in posterior circulation aneurysm

Institutional experience of microsurgical management in posterior circulation aneurysm

Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America

Multimodality techniques in microsurgical clipping as the gold standard treatment in the management of basilar tip aneurysm: A case series

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