Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms: A Study of 52 cases over 10 years.

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Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms: A Study of 52 cases over 10 years.

World Neurosurg. 2017 Sep 09;:

Authors: Tjahjadi M, Rezai-Jahromi B, Serrone J, Nurminen V, Choque-Velasquez J, Kivisaari R, Lehto H, Niemelä M, Hernesniemi J

Abstract
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 treatment's efficacy and safety.
MATERIAL AND METHODS: A retrospective analysis was conducted on clinical and radiological data from surgeries where 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 - 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 WFNS grade 1-3, and 15 patients (29%) with WFNS 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 was 2 and in unruptured cases all patients had favorable clinical outcomes. The main cause of unfavorable outcome were poor pre-operative clinical grade (P= .002), pre-operative intraventricular hemorrhage (IVH) (P=.008), post-operative HCP (P=.003), brain infarction (P = .005), post-operative pneumonia (P < .001).
CONCLUSIONS: We have described a 10-year experience using a simple lateral suboccipital approach and its modification by the senior author (J.H.) to treat VA and proximal PICA aneurysms. Unfavorable outcome was related to the poor pre-operative clinical grade, pre-operative intraventricular hemorrhage, and post-operative pneumonia.

PMID: 28899830 [PubMed - as supplied by publisher]

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