Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki
Autor: | Behnam Rezai Jahromi, Joham Choque-Velasquez, Juha Hernesniemi, Mario K. Teo, Peeraphong Thiarawat, Danil A. Kozyrev, Patcharin Intarakhao |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male medicine.medical_specialty Microsurgery Subarachnoid hemorrhage medicine.medical_treatment Neurosurgical Procedures Anterior clinoid process 03 medical and health sciences Young Adult 0302 clinical medicine medicine.artery medicine Humans cardiovascular diseases Posterior communicating artery Finland Computed tomography angiography Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Disease Management Intracranial Aneurysm Clipping (medicine) Middle Aged medicine.disease Surgery Cerebral Angiography medicine.anatomical_structure 030220 oncology & carcinogenesis cardiovascular system Female Neurology (clinical) Radiology Internal carotid artery business 030217 neurology & neurosurgery Cerebral angiography |
Zdroj: | World neurosurgery. 101 |
ISSN: | 1878-8769 |
Popis: | The objectives of this study were to analyze microsurgical techniques and to determine correlations between microsurgical techniques and the radiographic findings in the microneurosurgical treatment of posterior communicating artery aneurysms (PCoAAs).We retrospectively analyzed radiographic findings and videos of surgeries in 64 patients with PCoAAs who underwent microsurgical clipping by the senior author from August 2010 to 2014.From 64 aneurysms, 30 (47%) had acute subarachnoid hemorrhage (SAH) that necessitated lamina terminalis fenestration (odds ratio [OR], 67.67; P0.001) and Liliequist membrane fenestration (OR, 19.62; P0.001). The low-lying aneurysms significantly necessitated the coagulation of the dura covering the anterior clinoid process (ACP) (OR, 7.43; P = 0.003) or anterior clinoidectomy (OR, 91.0; P0.001). We preferred straight clips in 45 (83%) of 54 posterolateral projecting aneurysms (OR, 45.0; P0.001), but preferred curved clips for posteromedial projecting aneurysms (OR, 6.39; P = 0.008). The mean operative time from the brain retraction to the final clipping was 17 minutes and 43 seconds. Postoperative computed tomography angiography revealed complete occlusion of 60 (94%) aneurysms. Three (4.6%) patients with acute SAH suffered postoperative lacunar infarction.For ruptured aneurysms, lamina terminalis and Liliequist membrane fenestration are useful for additional cerebrospinal fluid drainage. For low-lying aneurysms, coagulation of the dura covering the ACP or tailored anterior clinoidectomy might be necessary for exposing the proximal aneurysm neck. Type of clips depends on the direction of projection. The microsurgical clipping of the PCoAAs can achieve good immediate complete occlusion rate with low postoperative stroke rate. |
Databáze: | OpenAIRE |
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