Details

Autor(en) / Beteiligte

• Goehre, Felix
• Lehecka, Martin
• Jahromi, Behnam Rezai
• Lehto, Hanna
• Kivisaari, Riku
• Hijazy, Ferzat
• Nayeb, Lamia
• Sugimoto, Tetsuaki
• Morishige, Masaki
• Elsharkawy, Ahmed
• von und zu Fraunberg, Mikael
• Jääskeläinen, Juha E
• Hernesniemi, Juha A

Titel

Subtemporal Approach to Posterior Cerebral Artery Aneurysms

Ist Teil von

• World neurosurgery, 2015-05, Vol.83 (5), p.842-851

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

ScienceDirect

Beschreibungen/Notizen

• Objective Aneurysms of the posterior cerebral artery (PCA) are rare, and therefore the individual and institutional experience of their microsurgical management is usually limited. In the present article, we describe our experience with the subtemporal approach to aneurysms arising from the PCA. Methods We reviewed 34 patients diagnosed with 37 PCA aneurysms, all microsurgically managed using the subtemporal approach between 1980 and 2012 at 2 Finnish neurosurgical centers (Helsinki and Kuopio). The following procedures were applied using the subtemporal approach: neck clipping (n = 24); proximal occlusion (n = 7); trapping (n = 2); wrapping (n = 1); aneurysmoraphy (n = 1); bypass bridging/trapping (n = 1); and a complex excimer laser-assisted nonocclusive anastomosis procedure (n = 1). Results Of these 34 patients, 16 presented with acute subarachnoid hemorrhage as a result of PCA aneurysm rupture, and 11 of the 16 had good outcome (modified Rankin scale 0–2) at 3 months The remaining 18 patients were treated microsurgically for incidentally diagnosed unruptured aneurysms, and 14 of the 18 had a good outcome. The most common serious complication in this series was an ipsilateral PCA infarction (12/34; 35%), mostly after proximal occlusion (n = 7) and/or trapping (n = 2). Conclusions The subtemporal approach is a suitable approach to aneurysms of the segments P1, P1–P2 junction, and P2, as well as the anterior P3 segment of the PCA. Using the subtemporal approach, the cerebrospinal fluid is released before retraction is necessary to prevent temporal lobe injury. The subtemporal approach can provide enough space for revascularization procedures. The most encountered complications were not related to the subtemporal approach but to the specific nature of PCA aneurysms.