Technical nuances of subtemporal approach for the treatment of basilar tip aneurysm

Nakov, Vladimir; Spiriev, Toma; Todorov, Ivan; Simeonov, Plamen

doi:10.4103/2152-7806.199555

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…A proper arachnoid dissection and separation between structures such as arteries, veins, and between two lobes and nerves will allow more clearer pathway toward the target. A previous thought of having the shortest route and hence spending minimal time to reach a target as the best surgical strategy mentioned in an article[ 12 ] may not be so true if the selected path needs a remarkable degree of brain retraction. The advancement in microneurosurgical techniques and instruments allows neurosurgeons to do sufficient arachnoid dissection without compromising any neural tissues and blood vessels.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…It is not wise to choose the shortest pathway if it causes maximum brain retraction. [ 22 ] Proper bony work is very essential to avoid unnecessary brain retraction such as anterior clinoid drilling in high riding basilar tip aneurysm, posterior clinoid drilling in a low riding basilar tip or basilar trunk aneurysm and jugular tubercle, and occipital condyle drilling in VA-PICA aneurysm. Studies suggest that in the case of brain retraction, dynamic brain retraction is better than rigid retraction.…”

Section: Discussionmentioning

confidence: 99%

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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“…Our patient's aneurysm was 10 mm above the dorsum sellae, thereby qualifying it to be a high-riding aneurysm. [1]…”

Section: Discussionmentioning

confidence: 99%

“…Some difficulties may be faced if the aneurysm is high riding. [111] Arachnoid dissection for exposure of the aneurysm can be through the pretemporal or transsylvian approaches. [10121314] Both the anterior temporal and the transsylvian approaches were used in this case because of the presence of other aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Basilar tip aneurysms are one of the most complex vascular lesions to treat surgically because of their location, depth of the approach, and close proximity of vital neurovascular structures such as the mesencephalon, cranial nerves, major vessels, and perforating arteries to the thalamus. [1] In the last few years, there has been a shift from microsurgical clipping to endovascular therapy in patients with basilar apex aneurysm. Part of this phenomenon has been related to the risk of intraoperative rupture and the risk of vital perforators like the thalamobasilar to be involved in the aneurysm dissection and clipping, resulting in unfavorable outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Anterior temporal approach and clipping of a high-riding basilar tip aneurysm: Case report and review of the surgical technique

et al. 2019

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Basilar apex aneurysms constitute 5%–8% of all intracranial aneurysms. Microsurgical clipping of basilar tip aneurysms is still advocated for as it is safe, especially for unruptured basilar tip aneurysms which have a low risk of postoperative mortality or morbidity. Careful patient preparation is needed preoperatively because the risk of intraoperative rupture is significant. Good surgical techniques should be applied. The skill will need to be preserved as endovascular surgery becomes more popular. This is a case of basilar tip aneurysm managed by clipping through the anterior temporal approach, followed by a review of the literature.

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Technical nuances of subtemporal approach for the treatment of basilar tip aneurysm

Cited by 10 publications

References 31 publications

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

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

Institutional experience of microsurgical management in posterior circulation aneurysm

Anterior temporal approach and clipping of a high-riding basilar tip aneurysm: Case report and review of the surgical technique

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