• Felix Goehre, Takeshi Yanagisawa, Hiroyasu Kamiyama, Kosumo Noda, Nakao Ota, Toshiyuki Tsuboi, Shiro Miyata, Takashi Matsumoto, Tarik F Ibrahim, Hugo Andrade-Barazarte, Christopher Ludtka, Behnam Rezai Jahromi, Sadahisa Tokuda, and Rokuya Tanikawa.
• Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan; Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany. Electronic address: fgoehre@gmail.com.
• World Neurosurg. 2016 Feb 1; 86: 497-502.

BackgroundAcute basilar artery occlusion is associated with high mortality rates, up to 35%-40%. Early revascularization by intravenous thrombolysis, intra-arterial thrombolysis, and endovascular mechanical embolectomy is considered the best option to date. The objective of this technical report is to present the direct microsurgical embolectomy technique for an acute distal basilar artery occlusion as an urgent life-saving revascularization procedure.MethodsA 71-year-old male patient suffered from an acute embolic basilar artery occlusion and became unconscious (Glasgow Coma Scale 4). Computed tomography angiography and MRA revealed the distal basilar artery occlusion along with an increased diffusion-weighted imaging signal in the corresponding territory. After an individual case discussion, the patient underwent a microsurgical embolectomy via a frontotemporal craniotomy and an anterior temporal approach.ResultsIntraoperative indocyanine green and postoperative computed tomography angiography revealed complete revascularization of the previously occluded basilar quadfurcation. The patient steadily recovered and was able to walk with assistance after 4 weeks.ConclusionsMicrosurgical embolectomy can be an effective treatment option for acute distal basilar artery occlusion in selected cases with experienced surgeons, but a critical preoperative decision-making process is needed.Copyright © 2016 Elsevier Inc. All rights reserved.

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