• World Neurosurg · Dec 2017

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

    • Mardjono Tjahjadi, Rezai Jahromi Behnam B Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Joseph Serrone, Ville Nurminen, Joham Choque-Velasquez, Riku Kivisaari, Hanna Lehto, Mika Niemelä, and Juha Hernesniemi.
    • Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: mardjonotjahjadi@gmail.com.
    • World Neurosurg. 2017 Dec 1; 108: 336-346.

    IntroductionComplex 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.MethodsA 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.ResultsFifty-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 < 0.001).ConclusionsWe describe 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 preoperative clinical grade, preoperative intraventricular hemorrhage, and postoperative pneumonia.Copyright © 2017 Elsevier Inc. All rights reserved.

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