Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms : A Study of 52 Cases Over 10 Years
| Autor: | Hanna Lehto, Juha Hernesniemi, Ville Nurminen, Joham Choque-Velasquez, Joseph C. Serrone, Behnam Rezai Jahromi, Mardjono Tjahjadi, Mika Niemelä, Riku Kivisaari |
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| Přispěvatelé: | Neurokirurgian yksikkö, Clinicum, Department of Neurosciences, HUS Neurocenter, HUS Heart and Lung Center |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Microsurgery medicine.medical_treatment CRANIOVERTEBRAL JUNCTION 3124 Neurology and psychiatry 030218 nuclear medicine & medical imaging Ventriculostomy 0302 clinical medicine Postoperative Complications INSTITUTIONAL EXPERIENCE Modified Rankin Scale Medicine Craniotomy Vertebral Artery Aged 80 and over Vertebral artery aneurysm OCCIPITAL CONDYLE POSTERIOR CIRCULATION ANEURYSMS Endovascular Procedures Middle Aged Lateral suboccipital approach Occipital condyle 3. Good health medicine.anatomical_structure Intraventricular hemorrhage Treatment Outcome SURGICAL-TREATMENT Female Radiology INTRAOPERATIVE RUPTURE Hydrocephalus Adult medicine.medical_specialty DISSECTING ANEURYSMS Vertebral artery INFERIOR CEREBELLAR ARTERY Patient Positioning 03 medical and health sciences Aneurysm medicine.artery Aneurysm clipping Humans TRANSCONDYLAR APPROACH cardiovascular diseases Aged Retrospective Studies business.industry 3112 Neurosciences Intracranial Aneurysm medicine.disease 3126 Surgery anesthesiology intensive care radiology Surgery Posterior inferior cerebellar artery ENDOVASCULAR TREATMENT Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Popis: | 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 |
| Databáze: | OpenAIRE |
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