Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms : A Study of 52 Cases Over 10 Years

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Tjahjadi , M , Jahromi , B R , Serrone , J , Nurminen , V , Choque-Velasquez , J , Kivisaari , R , Lehto , H , Niemelä , M & Hernesniemi , J 2017 , ' Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms : A Study of 52 Cases Over 10 Years ' , World Neurosurgery , vol. 108 , pp. 336-346 . https://doi.org/10.1016/j.wneu.2017.09.014

Title: Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms : A Study of 52 Cases Over 10 Years
Author: Tjahjadi, Mardjono; Jahromi, Behnam Rezai; Serrone, Joseph; Nurminen, Ville; Choque-Velasquez, Joham; Kivisaari, Riku; Lehto, Hanna; Niemelä, Mika; Hernesniemi, Juha
Contributor organization: Neurokirurgian yksikkö
Clinicum
Department of Neurosciences
HUS Neurocenter
HUS Heart and Lung Center
Date: 2017-12
Language: eng
Number of pages: 11
Belongs to series: World Neurosurgery
ISSN: 1878-8750
DOI: https://doi.org/10.1016/j.wneu.2017.09.014
URI: http://hdl.handle.net/10138/298144
Abstract: INTRODUCTION: Complex skull base approaches are frequently used to treat intracranial vertebral artery (VA) and proximal posterior inferior cerebellar artery (PICA) aneurysms. These complex procedures are associated with higher risk of neurovascular injury. Hence, a less-invasive surgical approach is needed to improve the efficacy and safety of treatment. METHODS: A retrospective analysis was conducted on clinical and radiologic data from surgeries in which simple lateral suboccipital and "lateral-enough" approaches were used to clip VA aneurysms in the Department of Neurosurgery at Helsinki University Central Hospital from 2000 to 2009. RESULTS: Fifty-two VA or PICA aneurysms were treated using the simple lateral suboccipital approach. Sixteen patients (31%) presented with an unruptured aneurysm, 21 patients (40%) with World Federation of Neurosurgical Societies (WFNS) grade 1-3, and 15 patients (29%) with World Federation of Neurosurgical Societies grade 4-5. The aneurysms were saccular in 48 cases (92%), dissecting in 3 cases (6%), and fusiform in 1 case (2%). The most common aneurysm location was the VA-PICA junction (81%). The mean final modified Rankin Scale score was 2, and in unruptured cases, all patients had favorable clinical outcomes. The main causes of unfavorable outcome were poor preoperative clinical grade (P = 0.002), preoperative intraventricular hemorrhage (P = 0.008), postoperative hydrocephalus (P = 0.003), brain infarction (P = 0.005), and postoperative pneumonia (P <0.001). CONCLUSIONS: We describe a 10-year experience using a simple lateral suboccipital approach and its modification by the senior author (J.H.) to treat VA and proximal PICA aneurysms. Unfavorable outcome was related to the poor preoperative clinical grade, preoperative intraventricular hemorrhage, and postoperative pneumonia.
Subject: Aneurysm clipping
Lateral suboccipital approach
Vertebral artery aneurysm
INFERIOR CEREBELLAR ARTERY
POSTERIOR CIRCULATION ANEURYSMS
ENDOVASCULAR TREATMENT
TRANSCONDYLAR APPROACH
SURGICAL-TREATMENT
CRANIOVERTEBRAL JUNCTION
INTRAOPERATIVE RUPTURE
DISSECTING ANEURYSMS
OCCIPITAL CONDYLE
INSTITUTIONAL EXPERIENCE
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion


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