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

2/8/2019 12:00:00 AM

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Authors: Mardjono Tjahjadi, Mika  Niemela¨ , Juri Kivelev,  Joseph Serrone, Hidetsugu Maekawa, Behnam Rezai  Jahromi, Oleg  Kerro,  Ahmad Hafez,  Hanna Lehto, Riku Kivisaari, Juha Hernesniemi

Publication date: Epub 2016 May 10.

World Neurosurg.

Volume: 92:313-322. doi: 10.1016/j.wneu.2016.05.001.

https://helda.helsinki.fi//bitstream/handle/10138/224032/1_s2.0_S1878875016302625_main.pdf?sequence=1

 

 

OBJECTIVE: The presigmoid  approach  can  be  used  to treat   vertebrobasilar   artery   aneurysms   when   circum- stances  require  more operative  exposure.  High morbidity and mortality in these  cases  have been  reported. In this study, we describe  our modified presigmoid approach  for vertebrobasilar  artery aneurysms and our clinical  results.

METHODS: This  series   includes  patients   with  verte- brobasilar aneurysms clipped via the modified presigmoid approach  at the Department of Neurosurgery at  Helsinki University Hospital from 1998 to 2014. Data were collected from the operating record books, patients’ medical records, and a radiologic database  server.

RESULTS: Thirty-three presigmoid procedures  of 31 pa- tients were  performed to treat 34 aneurysms (14 ruptured,

20 unruptured). The aneurysms had a mean distance  from the posterior clinoid process  to the aneurysm neck of 12.2 mm (range, 0e26.6 mm). A favorable outcome was achieved in 21 patients (64%). A favorable outcome was achieved in

74% of unruptured and good-grade patients,  whereas favorable outcome was achieved in only 36% of poor-grade patients.  Complete or near-complete  occlusion  was  ach- ieved in 79%. Larger aneurysms, fusiform morphology, and anterior dome projection had lower occlusion rates.

CONCLUSIONS: We have described  our experiences of using the presigmoid approach to treat vertebrobasilar aneurysms. The clinical and radiographic results are acceptable given the complex location and configuration of  the   treated   aneurysms.   Unfavorable  outcomes   are related to the poor admission Hunt and Hess grade, aneu- rysm morphology, and aneurysm size.

Key words: Angioplasty, Aortic arch reconstruction, Arterial occlusive disease, Intracranial stenting, Mechanical thrombolysis, Stroke