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Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature.

Nair P, Panikar D, Nair AP, Sundar S, Ayiramuthu P, Thomas A - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: At 6 months follow-up, 10/14 (71%) patients had mRS of 0-2, and 2 (14%) had mRS of 5.They commonly present with SAH.The EDTP approach avoids complication caused by temporal lobe retraction and injury to the vein of Labbe.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Objective: This is a retrospective study from January 2002 to December 2012 analyzing the results of microsurgical clipping for aneurysms arising from the superior cerebellar artery (SCA).

Materials and methods: All patients with SCA were evaluated with computerized tomography angiography and/or digital subtraction angiography (DSA) prior to surgery. All patients in our series underwent microsurgical clipping and postoperative DSA to assess the extent of aneurysm occlusion. The Glasgow outcome scale (GOS) and the modified Rankin's scale (mRS) were used to grade their postoperative neurological status at discharge and 6 months, respectively.

Results: Fourteen patients had SCA aneurysms (ruptured-9, unruptured-5). There were 10 females and 4 males with the mean age of 47.2 years (median - 46 years, range = 24-66 years). Subarachnoid hemorrhage (SAH) was seen in 11 patients. The mean duration of symptoms was 2.5 days (range = 1-7 days). The WFNS score at presentation was as follows: Grade 1 in 10 cases, II in 2 cases, III in 1 case and IV in 1 case. In the 9 cases with ruptured SCA aneurysm, average size of the ruptured aneurysms was 7.3 mm (range = 2.5-27 mm, median = 4.9 mm). The subtemporal approach was used in the first 7 cases. The extradural temporopolar (EDTP) approach was used in the last 5 cases. Complications include vasospasm (n = 6), third nerve palsy (n = 5) and hydrocephalus (n = 3). Two patients died following surgery. At mean follow-up 33.8 months (median - 25 months, range = 19-96 months), no patient had a rebleed. At discharge 9 (64%), had a GOS of 4 or 5 and 3 (21%) had a GOS of 3. At 6 months follow-up, 10/14 (71%) patients had mRS of 0-2, and 2 (14%) had mRS of 5.

Conclusions: Aneurysms of the SCA are uncommon and tend to rupture even when the aneurysm size is small (<7 mm). They commonly present with SAH. The EDTP approach avoids complication caused by temporal lobe retraction and injury to the vein of Labbe.

No MeSH data available.


Related in: MedlinePlus

(a) CT showed SAH with a hematoma in the left temporal lobe in a 45-year-old male seen in the emergency with sudden onset headache and loss of consciousness. (b) DSA showing a left MCA and ICA aneurysm, and (c) shows a superiorly directed SCA aneurysm. (d) Operative pictures seen through a subtemporal approach with the aneurysm arising from the SCA, the oculomotor nerve and PCA are seen in close relation. (e) The final clip placement across the aneurysm, and (f) DSA showing complete occlusion of the aneurysm
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Figure 2: (a) CT showed SAH with a hematoma in the left temporal lobe in a 45-year-old male seen in the emergency with sudden onset headache and loss of consciousness. (b) DSA showing a left MCA and ICA aneurysm, and (c) shows a superiorly directed SCA aneurysm. (d) Operative pictures seen through a subtemporal approach with the aneurysm arising from the SCA, the oculomotor nerve and PCA are seen in close relation. (e) The final clip placement across the aneurysm, and (f) DSA showing complete occlusion of the aneurysm

Mentions: Case 2: A 45-year-old male was seen in the emergency with sudden onset headache and loss of consciousness. He had hemiparesis on the right side. CT showed SAH with a hematoma in the left temporal lobe. Angiogram showed a left MCA aneurysm, right ICA and left SCA aneurysms. He underwent surgery for clipping of the ruptured left aneurysm. Following surgery, he had a brain swelling, and the bone flap was not replaced. Over the next 1-year, he could stand with support but began to develop hydrocephalus. After 15 months, he underwent VP shunt, bone flap re-implantation and simultaneous clipping of the left SCA and right MCA. At 2 years follow-up, he has residual right hemiparesis is dependent on caregivers for daily activities [case 5, Table 2 and Figure 2a–f].


Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature.

Nair P, Panikar D, Nair AP, Sundar S, Ayiramuthu P, Thomas A - Asian J Neurosurg (2015 Jan-Mar)

(a) CT showed SAH with a hematoma in the left temporal lobe in a 45-year-old male seen in the emergency with sudden onset headache and loss of consciousness. (b) DSA showing a left MCA and ICA aneurysm, and (c) shows a superiorly directed SCA aneurysm. (d) Operative pictures seen through a subtemporal approach with the aneurysm arising from the SCA, the oculomotor nerve and PCA are seen in close relation. (e) The final clip placement across the aneurysm, and (f) DSA showing complete occlusion of the aneurysm
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352632&req=5

Figure 2: (a) CT showed SAH with a hematoma in the left temporal lobe in a 45-year-old male seen in the emergency with sudden onset headache and loss of consciousness. (b) DSA showing a left MCA and ICA aneurysm, and (c) shows a superiorly directed SCA aneurysm. (d) Operative pictures seen through a subtemporal approach with the aneurysm arising from the SCA, the oculomotor nerve and PCA are seen in close relation. (e) The final clip placement across the aneurysm, and (f) DSA showing complete occlusion of the aneurysm
Mentions: Case 2: A 45-year-old male was seen in the emergency with sudden onset headache and loss of consciousness. He had hemiparesis on the right side. CT showed SAH with a hematoma in the left temporal lobe. Angiogram showed a left MCA aneurysm, right ICA and left SCA aneurysms. He underwent surgery for clipping of the ruptured left aneurysm. Following surgery, he had a brain swelling, and the bone flap was not replaced. Over the next 1-year, he could stand with support but began to develop hydrocephalus. After 15 months, he underwent VP shunt, bone flap re-implantation and simultaneous clipping of the left SCA and right MCA. At 2 years follow-up, he has residual right hemiparesis is dependent on caregivers for daily activities [case 5, Table 2 and Figure 2a–f].

Bottom Line: At 6 months follow-up, 10/14 (71%) patients had mRS of 0-2, and 2 (14%) had mRS of 5.They commonly present with SAH.The EDTP approach avoids complication caused by temporal lobe retraction and injury to the vein of Labbe.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Objective: This is a retrospective study from January 2002 to December 2012 analyzing the results of microsurgical clipping for aneurysms arising from the superior cerebellar artery (SCA).

Materials and methods: All patients with SCA were evaluated with computerized tomography angiography and/or digital subtraction angiography (DSA) prior to surgery. All patients in our series underwent microsurgical clipping and postoperative DSA to assess the extent of aneurysm occlusion. The Glasgow outcome scale (GOS) and the modified Rankin's scale (mRS) were used to grade their postoperative neurological status at discharge and 6 months, respectively.

Results: Fourteen patients had SCA aneurysms (ruptured-9, unruptured-5). There were 10 females and 4 males with the mean age of 47.2 years (median - 46 years, range = 24-66 years). Subarachnoid hemorrhage (SAH) was seen in 11 patients. The mean duration of symptoms was 2.5 days (range = 1-7 days). The WFNS score at presentation was as follows: Grade 1 in 10 cases, II in 2 cases, III in 1 case and IV in 1 case. In the 9 cases with ruptured SCA aneurysm, average size of the ruptured aneurysms was 7.3 mm (range = 2.5-27 mm, median = 4.9 mm). The subtemporal approach was used in the first 7 cases. The extradural temporopolar (EDTP) approach was used in the last 5 cases. Complications include vasospasm (n = 6), third nerve palsy (n = 5) and hydrocephalus (n = 3). Two patients died following surgery. At mean follow-up 33.8 months (median - 25 months, range = 19-96 months), no patient had a rebleed. At discharge 9 (64%), had a GOS of 4 or 5 and 3 (21%) had a GOS of 3. At 6 months follow-up, 10/14 (71%) patients had mRS of 0-2, and 2 (14%) had mRS of 5.

Conclusions: Aneurysms of the SCA are uncommon and tend to rupture even when the aneurysm size is small (<7 mm). They commonly present with SAH. The EDTP approach avoids complication caused by temporal lobe retraction and injury to the vein of Labbe.

No MeSH data available.


Related in: MedlinePlus