Petrosal approaches to posterior circulation aneurysms

Abstract

<jats:p>Complex posterior circulation aneurysms are formidable lesions with an abysmal natural history. Their management continues to present a challenge to both endovascular and open microsurgical approaches. Affording an expansive, combined supra- and infratentorial exposure, the petrosal approaches are well suited for these challenging lesions when located along the basilar trunk or at a low-lying basilar apex. This report evaluates the evolution and application of petrosal approaches to these lesions. Excluding transsigmoid, infratentorial, or labyrinth-sacrificing approaches, the authors found 23 reports with 61 posterior circulation aneurysms treated via a petrosal approach. Although early morbidity was not negligible, rates of aneurysm occlusion (95% overall) and long-term outcome were quite laudable in light of the challenge posed by these lesions. Moreover, with accumulating experience with petrosal approaches, rates of complications are likely to wane, as neurosurgeons capitalize on the expansive exposure afforded by these indispensable approaches.</jats:p>

Presigmoid Approach to Vertebrobasilar Artery Aneurysms: A Series of 31 Patients and Review of the Literature

“…33,34 A current literature review of the posterior transpetrosal approach to aneurysms in the posterior circulation found reports of only 34 patients published in the last 20 years. 10 Our series comprises 33 procedures in 31 patients, making it the largest series to date; moreover, all the consecutive cases were treated by a single surgeon (J.H.) in a single center.…”

“…Recently, many less invasive variations of the presigmoid approach have been described, including retrolabyrinthine, transcrusal, minimum combined transpetrosal, and partial superoposterior petrosectomy. [6][7][8][9][10][11][12] However, the presigmoid approach still carries a relatively high morbidity (62%) and…”

“…Key words -Angioplasty -Aortic arch reconstruction -Arterial occlusive disease -Intracranial stenting -Mechanical thrombolysis -Stroke Abbreviations and Acronyms BA: Basilar artery CSF: Cerebrospinal fluid GOS: Glasgow Outcome Score PCP: Posterior clinoid process SPS: Superior petrosal sinus mortality (9%). 10,11 After the publication of the ISAT (International Subarachnoid Aneurysm Trial) and ISUIA (International Study of Unruptured Intracranial Aneurysms) trials reporting competitive results of endovascular therapy for aneurysm treatment, endovascular therapy has become more common in general and especially for treating posterior circulation aneurysms. [13][14][15] Nonetheless, not all vertebrobasilar aneurysms can be treated well by endovascular means.…”

The far-lateral craniotomy: tips and tricks

“…The vascular lesions varied from cavernous angiomas (9-21.4%) inside the brainstem, posterior inferior artery aneurysms (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).9%), vertebral junction aneurysms (3-7.1%), low third basilar artery aneurysms (2-4.7%), vertebral artery aneurysms (7)(8)(9)(10)(11)(12)(13)(14)(15)(16).6%), to arteriovenous malformations placed beside the brainstem (8-19.04%).…”

“…Care should be taken to avoid damage to the bridge venous between the sinus and the mastoid. Medially the bone may be resected in order to open the magnum foramen 9,10 . Depending on the target of the approach, varying from para condylar, supracondylar and transcondylar, resecting the condyle should be performed.…”