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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.


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(a) A 28-year-old man with SAH was found to have an upward directed aneurysm arising in the distal SCA (open arrow), which was approached by the temporopolar approach. (b) Postoperative angiogram after clipping shows complete occlusion of the aneurysm neck and flow through the parent vessel (closed arrow)
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Figure 6: (a) A 28-year-old man with SAH was found to have an upward directed aneurysm arising in the distal SCA (open arrow), which was approached by the temporopolar approach. (b) Postoperative angiogram after clipping shows complete occlusion of the aneurysm neck and flow through the parent vessel (closed arrow)

Mentions: The surgical options used for aneurysms arising from the SCA in our series include the subtemporal approach, alone in combination with the transsylvian corridor and the EDTP transcavernous approach.[151617181920] We feel that the main factors to be considered during surgery for these aneurysms include (1) height of the basilar bifurcation in relation to the posterior clinoids (2) direction of projection of the fundus (3) SCA origin in relation to the tentorial edge and (4) relationship of the SCA to the oculomotor nerve [Figures 1–6].


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) A 28-year-old man with SAH was found to have an upward directed aneurysm arising in the distal SCA (open arrow), which was approached by the temporopolar approach. (b) Postoperative angiogram after clipping shows complete occlusion of the aneurysm neck and flow through the parent vessel (closed arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: (a) A 28-year-old man with SAH was found to have an upward directed aneurysm arising in the distal SCA (open arrow), which was approached by the temporopolar approach. (b) Postoperative angiogram after clipping shows complete occlusion of the aneurysm neck and flow through the parent vessel (closed arrow)
Mentions: The surgical options used for aneurysms arising from the SCA in our series include the subtemporal approach, alone in combination with the transsylvian corridor and the EDTP transcavernous approach.[151617181920] We feel that the main factors to be considered during surgery for these aneurysms include (1) height of the basilar bifurcation in relation to the posterior clinoids (2) direction of projection of the fundus (3) SCA origin in relation to the tentorial edge and (4) relationship of the SCA to the oculomotor nerve [Figures 1–6].

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