Artikel
Rare indications for microsurgery of basilar apex aneurysms – own experience over the last 5 years
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Autoren
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Siamak Asgari
- Neurochirurgische Klinik, Klinikum Ingolstadt
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Dierk Vorwerk
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Ingolstadt
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: During the last 20 years, in North America and Europe, the majority of basilar apex aneurysms (BAAA) were treated by endovascular interventions, mainly coil embolization and stent-assisted coil embolization. Microsurgical clipping of these lesions disappeared from routine operative theatre even in neurovascular centers. But in rare instances, microsurgical clipping may be a safe and effective therapy in patients with BAAA in very experienced hands.
Method: During the last 5 years, six patients with BAAA underwent microsurgical clipping. The average age of patients was 56 years. Three patients suffered from subarachnoid haemorrhage (SAH), one patient from symptomatic midbrain compression (giant aneurysm), and two patients had asymptomatic aneurysm. One patient with asymptomatic BAAA was symptomatic due to a concomitant large left-sided medial sphenoid wing meningioma. Cerebral DSA, CT-angiography and MRI were performed preoperatively, DSA and CCT postoperatively in every patient. The intraoperative photographs and videos were analyzed postoperatively.
Results: Indication for microsurgery was small blister-like aneurysm in three patients, partially thrombosed giant aneurysm in one, extreme wide aneurysm neck formation in two patients. The pterional approach without orbito-zygomatic enlargement was used in every patient. Intraoperatively, the interoptic-carotid route was used in one patient and the lateral-carotid route in the other patients. Intraoperative aneurysm rupture occurred in one patient with SAH. In most of the patients, aneurysm ligation was performed with a Perneczky clip. No other complications occurred. Postoperative DSA showed complete aneurysm occlusion in 4 patients and small infundibular remnant in 2 patients. At the six-months-examination, all patients presented an excellent or good neurological result (GOS 5 in five patients, GOS 4 in one patient).
Conclusions: In rare constellations, microsurgical solution in therapy of BAAA is a favorable treatment modality with excellent neurological and radiological result. In such cases, the risk and benefit of both microsurgery and endovascular treatment have to be compared by the neurovascular board. Naturally, the skills and experience of the microneurosurgeon are crucial in decision making.
