Saratov JOURNAL of Medical and Scientific Research

Extended retrosigmoid retrocondylar access in microsurgery of posterior inferior cerebellar artery aneurysms in the acute period of hemorrhage (clinical case)

Year: 2022, volume 18 Issue: №2 Pages: 197-201
Heading: neurosurgery Article type: Case report
Authors: Dzhindzhikhadze R.S., Lazarev V.A., Kambiev R.L., Polyakov A.V., Bogdanovich I.O., Dreval O.N., Ermolaev A.Yu., Chekhonatskiy V.A.
Organization: Moscow Regional Research and Clinical Institute ("MONIKI")
Summary:

Objective: using the example of clinical observation to describe the features of a new method of surgical treatment of aneurysms at the mouth of the posterior inferior cerebellar artery (PICA), in the area of the anterior and lateral medullary segments. Despite a wide range of traditional surgical and minidomes, there is no consensus on the choice of a particular access for cerebral aneurysms. Suggested indications and contraindications for aneurysm treatment methods vary from author to author. The extended retrosigmoid retrocondylar access we use is safe and effective and can be a good alternative in microsurgery of PICA aneurysms in the acute period of hemorrhage. In this clinical example we demonstrate a new surgical approach to the treatment of aneurysms in the PICA orifice based on the experience formed in the clinic with a significant volume of patients (more than 200 annually) operated on in the first 48 hours after hemorrhage, which can be used in practice and allows achieving the fastest early patient activation and reducing the period of medical and social rehabilitation.

Bibliography:
1. Brown RD Jr, Broderick J. Unruptured intracranial an-eurysms: epidemiology, natural history, management options, and familial screening. The Lancet Neurology 2014; 13 (4): 393-404.
2. Cebral J, Castro M, Burgess J. et al. Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. American Journal of Neuroradiology 2005; 26 (10): 2550-9.
3. Spetzler RF, Kalani YS, Nakaji P. Neurovascular surgery. 2nd edition. N. Y: Thieme medical publishers, 2015; 1238 p.
4. Starmoni D, Maduri R, Al Taha K, et al. Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study. Acta Neurochirurgica 2019; (161): 1325-34.
5. Williamson RW, Wilson DA, Abla AA, et al. Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: A comparative analysis. J Neurosurg 2015; (123): 441-5.
6. Rutledge CW, Lawton MT. Basilar artery aneurysm: role for open surgery. In: Veznedaroglu E, ed. Controversies in vascular neurosurgery. Cham: Springer International Publishing Switzerland, 2016; p. 83-92.
7. Fomkina OA. Morphology of intracranial parts of vertebrates, basilar, cerebellar and posterior cerebral arteries in adults of different ages and sexes: PhD diss. Volgograd, 2006; 123 p.
8. Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar circulation artery lesions. J Neurosurgery 1986; (64): 559-62.
9. Winn H, Jane J, Taylor J, et al. Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms. Journal of Neurosurgery 2002; 96 (1): 43-9.
10. AboukaTs R, Zairi F, Boustia F, et al. Vertebral artery-posterior inferior cerebellar artery convergence aneurysms treated byendovascular or surgical treatment: Mid- and long-term outcome. Neurochirurgie 2016; 62 (2): 72-7.
11. Eliava ShSh, Pilipenko luV, Shekhtman OD, et al. Microsurgical treatment of aneurysms of vertebral and posterior-lower cerebellar arteries: surgical approaches, exclusion options, treatment results. Burdenko's Journal of Neurosurgery 2019; 83 (4): 5-17.
12. Wong J, Tymanski R, Radovanovic I, et al. Minimally invasive microsurgery for cerebral aneurysms. Stroke 2015; 46 (9): 2699-706.
13. Hammon WM, Kempe LG. The posterior fossa approach to aneurysms of the vertebral and basilar arteries. J Neurosurg 1972; 37(3): 339-47.
14. Rohde V, Schaller C, Hassler W. The extreme lateral transcondylar approach to aneurysms of the vertebrobasilar junction, the vertebral artery, and the posterior inferior cerebellar artery. Skull Base Surg 1994; (4): 77-180.
15. Seoane P, Kalb S, Clark JC, et al. Far-lateral approach without drilling the occipital condyle for vertebral artery-posterior inferior cerebellar artery aneurysms. Neurosurgery 2017; (81): 268-74.
16. Viswanathan GC, Menon G, Nair S, et al. Posterior inferior cerebellar artery aneurysms: Operative strategies based on a surgical series of 27 patients. Turkish Neurosurgery 2014; 24(1): 30-7.
17. Pilipenko Y, Eliava S, Okishev D, et al. Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients. Surg Neurol Int 2019; (227): 1-11.
18. Deora H, Nayak N, Dixit P, et al. Surgical management and outcomes of aneurysms of posterior inferior cerebellar artery: Location-based approaches with review of literature. J Neurosci Rural Pract 2020; (11): 34-43.
19. Singh KR, Behari S, Kumar V, et al. Posterior inferior cerebellar artery aneurysms: Anatomical variations and surgical strategies. Asian J Neurosurg 2012; (7): 2-11.
20. Dashiyan VG, Senko IV Microsurgical treatment of distal aneurysms of the posterior inferior cerebellar artery. Neurosurgery 2019; (21): 12-23.

AttachmentSize
2022_2_197-201.pdf1.17 MB

No votes yet