Surgical Management of the Acutely Ruptured Posterior Circulation Aneurysm

AbstractBACKGROUNDThe treatment of selected wide-neck and fusiform posterior circulation aneurysms is challenging for clipping as well as for endovascular route.OBJECTIVETo describe an endovascular approach for vertebral artery aneurysm treatment using transradial access (TRA) instead of the conventional transfemoral access.METHODSWe collected cases from two institutions in which TRA was used for posterior circulation Pipeline Embolization Device (Medtronic, Dublin, Ireland) deployment.RESULTSA total of four patients were treated. TRA was useful in the setting of extreme vessel tortuosity. We utilized 5F Terumo Glidesheath (Terumo Medical, Somerset, New Jersey), intermediate catheter, and a 027 microcatheter for Pipeline deployment. TRA was not associated with any access or deployment difficulties.CONCLUSIONSEarly experience suggests that TRA for Pipeline Embolization Device placement for posterior circulation aneurysm is a safe and efficient alternative to standard transfemoral access. While this approach was initially applied to patients with vascular anatomy that may not allow for safe femoral access or navigation, experience so far argues for considering a radial approach towards some posterior circulation aneurysm treatment.

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Surgical management of unruptured basilar artery bifurcation aneurysms

Neurosurgical FOCUS ◽

10.3171/foc.2002.13.3.4 ◽

2002 ◽

Vol 13 (3) ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Aaron S. Dumont ◽

Rod J. Oskouian ◽

Michael M. Chow ◽

Neal F. Kassell

Keyword(s):

Surgical Management ◽

Basilar Artery ◽

Intracranial Aneurysms ◽

Present Report ◽

Posterior Circulation ◽

Common Site ◽

Unruptured Aneurysms ◽

Radiological Data ◽

The Rich ◽

The Individual

The basilar artery (BA) bifurcation is the most common site for aneurysms arising from the posterior circulation. Their inhospitable location, nested within the narrow confines of the interpeduncular fossa anterior to the brainstem, coupled with the rich network of adjacent critical thalamoperforating arteries irrigating the midbrain and thalamus, pose difficult anatomical obstacles for the surgeon. The age old adage that the only cure for intracranial aneurysms remains exclusion from circulation before rupture still holds true. Although management of unruptured aneurysms in general is still controversial, unruptured aneurysms of the BA bifurcation can be treated surgically with acceptable rates of morbidity. The clinician must gather and weigh all clinical, pathological, and radiological data when formulating recommendations for the individual patient. In the present report the authors describe their current technique for the surgical management of unruptured BA bifurcation aneurysms; this represents the culmination of the senior author's (N.K.) experience in the management of both ruptured and unruptured BA bifurcation aneurysms. A modified, right-sided subtemporal transtentorial approach has been adopted in all cases of isolated unruptured BA bifurcation aneurysms. Technical nuances are described.

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Transient Amnesia After Coiling of a Posterior Circulation Aneurysm

Neurocritical Care ◽

10.1007/s12028-012-9774-1 ◽

2012 ◽

Vol 18 (2) ◽

pp. 245-247 ◽

Cited By ~ 8

Author(s):

Jonathan Graff-Radford ◽

Allison J. Clapp ◽

Giuseppe Lanzino ◽

Alejandro A. Rabinstein

Keyword(s):

Posterior Circulation ◽

Posterior Circulation Aneurysm

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The Relevance of Microsurgical Management of Non-Basilar Posterior Circulation Aneurysm in the Current Era of Endovascular Management

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336203 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Ashish Sonig ◽

Ambekar Sudheer ◽

Anil Nanda

Keyword(s):

Posterior Circulation ◽

Endovascular Management ◽

Posterior Circulation Aneurysm

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26 Surgical Management of Posterior Circulation Aneurysms

Surgery of the Brainstem ◽

10.1055/b-0039-173917 ◽

2020 ◽

Keyword(s):

Surgical Management ◽

Posterior Circulation ◽

Posterior Circulation Aneurysms

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Preoperative factors affecting the outcome of unruptured posterior circulation aneurysm surgery

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2010.07.121 ◽

2011 ◽

Vol 18 (1) ◽

pp. 85-89 ◽

Cited By ~ 11

Author(s):

Behzad Eftekhar ◽

Michael Kerin Morgan

Keyword(s):

Posterior Circulation ◽

Aneurysm Surgery ◽

Factors Affecting ◽

Posterior Circulation Aneurysm ◽

Preoperative Factors

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Cranial base approaches to posterior circulation aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1997.87.4.0544 ◽

1997 ◽

Vol 87 (4) ◽

pp. 544-554 ◽

Cited By ~ 81

Author(s):

J. Diaz Day ◽

Takanori Fukushima ◽

Steven L. Giannotta

Keyword(s):

Surgical Management ◽

Cranial Base ◽

Posterior Circulation ◽

Management Options ◽

Content Type ◽

Technical Challenge ◽

Complex Aneurysms ◽

Posterior Circulation Aneurysms ◽

Vertebrobasilar Circulation ◽

Fine Print

✓ Aneurysms arising from the posterior circulation, especially when they are large and complex, continue to present a technical challenge. The development of cranial base strategies and principles has added to surgical management options. The authors used one of four cranial base approaches for the treatment of 30 patients with large and/or complex aneurysms arising from the vertebrobasilar circulation. These approaches included the extradural temporopolar, combined petrosal, retrolabyrinthine—transsigmoid, and the extreme-lateral inferior transtubercular exposure. The indications, technique, and results of each approach in this series are discussed, and a management paradigm is suggested for such aneurysms.

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