Microsurgical Treatment Strategy of Vertebral Artery Fusiform Aneurysm—From the Standpoint of Hemodynamic Integrity and Perforator Preservation

During treatment of vertebral artery (VA) fusiform aneurysms, it is critical to preserve peripheral perforators and anterograde blood flow of the VA and to reduce hemodynamic load to the contralateral VA. Even in the era of endovascular treatment, there are still many benefits to using microsurgical treatments with appropriate clip application and preservation of the perforators around the aneurysm, in conjunction with various bypass techniques. The ideal microsurgical technique involves reconstructive clipping that obliterates the aneurysm but preserves anterograde blood flow of the VA, followed by isolation of the aneurysm and VA reconstruction. If these two methods are unavailable, proximal clipping of the aneurysm combined with flow-augmentation bypass to the distal branch can be considered as an alternative surgical management. We discuss the microsurgical treatment of unruptured VA fusiform aneurysms in our surgical cases on the basis of a review of the current literature.

Education of microsurgical technique for young surgeons by International Society for Experimental Microsurgery West Japan and future prospects

The need for microscopic vascular anastomosis has increased in the field of gastrointestinal surgery. Herein we report the activities for microsurgical training by ISEM West Japan.Since 2015, we have held the Hands-on seminar twice a year using artificial blood vessel. The participants sutured it with 9-0 polypropylene suture under bench microscopes. Competitions for microsurgical arterial anastomosis were held in the seminar, in which we evaluated the anastomosis regarding the leakage and patency.Totally 208 participants attended the hands-on seminar. No relation was seen between the years of surgical experience and the score. However, there was a relation between the number of participation and the score.Through our hands-on seminar, young surgeon could improve technique and motivation for the microsurgery.

How I do it: endoscopic endonasal resection of tuberculum sellae meningioma

Background Tuberculum sellae meningiomas (TSMs) adherent to neurovascular structures are particularly challenging lesions requiring delicate and precise microneurosurgery. There is an ongoing debate about the optimal surgical approach. Method We describe technical nuances and challenges in TSM resection using the endoscopic endonasal approach (EEA) in two cases of fibrous tumors with adherence to neurovascular structures. The cases are illustrated with a video (case 1) and figures (cases 1 and 2). Conclusion A dedicated team approach and precise microsurgical technique facilitate safe resection of complex TSMs through the EEA.