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Subtemporal approach to basilar tip aneurysm with division of posterior communicating artery: technical note.

Kakino S, Ogasawara K, Kubo Y, Nishimoto H, Ogawa A - Vasc Health Risk Manag (2008)

Bottom Line: We applied this procedure to a patient with a ruptured aneurysm of the basilar tip.The postoperative course was uneventful except for transient left oculomotor nerve palsy.The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan. skakino@iwate-med.ac.jp

ABSTRACT
The subtemporal approach with division of the posterior communicating artery (PcomA) is described for treating aneurysms of the basilar tip. When the ipsilateral posterior cerebral artery (PCA) interferes with visibility and manipulation around the aneurysm neck and the artery is tethered by the PcomA and not mobilized, the PcomA can be divided near the junction with the PCA. The procedure permits PCA mobilization and exposes the neck of the aneurysm. We applied this procedure to a patient with a ruptured aneurysm of the basilar tip. The postoperative course was uneventful except for transient left oculomotor nerve palsy. Postoperative cerebral angiography and magnetic resonance imaging confirmed the respective disappearance of the aneurysm and no new ischemic lesions. The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.

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Intraoperative findings. A: Left posterior cerebral artery (black arrow) runs just in front of neck of basilar tip aneurysm. B: Left posterior communicating artery (arrow head) is coagulated near the junction to the left posterior cerebral artery (black arrow) using bipolar forceps. Perforating artery originating from posterior communicating artery is visible (open arrow). C: Left posterior communicating artery is divided and aneurysm is widely exposed. Two clips applied before division of posterior communicating artery are visible. D: Aneurysm is clipped at the neck.
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f1-vhrm-4-0931: Intraoperative findings. A: Left posterior cerebral artery (black arrow) runs just in front of neck of basilar tip aneurysm. B: Left posterior communicating artery (arrow head) is coagulated near the junction to the left posterior cerebral artery (black arrow) using bipolar forceps. Perforating artery originating from posterior communicating artery is visible (open arrow). C: Left posterior communicating artery is divided and aneurysm is widely exposed. Two clips applied before division of posterior communicating artery are visible. D: Aneurysm is clipped at the neck.

Mentions: The PCA runs immediately in front of the neck of a basilar tip aneurysm (Figure 1A) and posterior manipulation of the PCA is necessary to fully expose the aneurysm. However, the PCA is tethered by the PcomA and is not mobilized. Firstly, the PcomA is coagulated near the junction to the PCA using bipolar forceps to avoid injuring the perforating arteries originating from the PcomA (Figure 1B). The coagulated PcomA is trapped with two Sugita AVM microclipsR (Mizuho Medical, Tokyo, Japan) and cut between the two clips (Figure 1C). Thus, the PCA is posteriorly mobilized and the neck of the basilar tip aneurysm is exposed, allowing easy clipping of the aneurysm (Figure 1D).


Subtemporal approach to basilar tip aneurysm with division of posterior communicating artery: technical note.

Kakino S, Ogasawara K, Kubo Y, Nishimoto H, Ogawa A - Vasc Health Risk Manag (2008)

Intraoperative findings. A: Left posterior cerebral artery (black arrow) runs just in front of neck of basilar tip aneurysm. B: Left posterior communicating artery (arrow head) is coagulated near the junction to the left posterior cerebral artery (black arrow) using bipolar forceps. Perforating artery originating from posterior communicating artery is visible (open arrow). C: Left posterior communicating artery is divided and aneurysm is widely exposed. Two clips applied before division of posterior communicating artery are visible. D: Aneurysm is clipped at the neck.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2597766&req=5

f1-vhrm-4-0931: Intraoperative findings. A: Left posterior cerebral artery (black arrow) runs just in front of neck of basilar tip aneurysm. B: Left posterior communicating artery (arrow head) is coagulated near the junction to the left posterior cerebral artery (black arrow) using bipolar forceps. Perforating artery originating from posterior communicating artery is visible (open arrow). C: Left posterior communicating artery is divided and aneurysm is widely exposed. Two clips applied before division of posterior communicating artery are visible. D: Aneurysm is clipped at the neck.
Mentions: The PCA runs immediately in front of the neck of a basilar tip aneurysm (Figure 1A) and posterior manipulation of the PCA is necessary to fully expose the aneurysm. However, the PCA is tethered by the PcomA and is not mobilized. Firstly, the PcomA is coagulated near the junction to the PCA using bipolar forceps to avoid injuring the perforating arteries originating from the PcomA (Figure 1B). The coagulated PcomA is trapped with two Sugita AVM microclipsR (Mizuho Medical, Tokyo, Japan) and cut between the two clips (Figure 1C). Thus, the PCA is posteriorly mobilized and the neck of the basilar tip aneurysm is exposed, allowing easy clipping of the aneurysm (Figure 1D).

Bottom Line: We applied this procedure to a patient with a ruptured aneurysm of the basilar tip.The postoperative course was uneventful except for transient left oculomotor nerve palsy.The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan. skakino@iwate-med.ac.jp

ABSTRACT
The subtemporal approach with division of the posterior communicating artery (PcomA) is described for treating aneurysms of the basilar tip. When the ipsilateral posterior cerebral artery (PCA) interferes with visibility and manipulation around the aneurysm neck and the artery is tethered by the PcomA and not mobilized, the PcomA can be divided near the junction with the PCA. The procedure permits PCA mobilization and exposes the neck of the aneurysm. We applied this procedure to a patient with a ruptured aneurysm of the basilar tip. The postoperative course was uneventful except for transient left oculomotor nerve palsy. Postoperative cerebral angiography and magnetic resonance imaging confirmed the respective disappearance of the aneurysm and no new ischemic lesions. The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.

Show MeSH
Related in: MedlinePlus