• World Neurosurg · Jun 2018

    Review Case Reports

    Multistage "Hybrid" (Open and Endovascular) Surgical Treatment of Vertebral Artery-Thrombosed Giant Aneurysm by Trapping and Thrombectomy.

    • Tomoya Suzuki, Shogo Kaku, Kengo Nishimura, Akihiko Teshigawara, Yuichi Sasaki, Ken Aoki, Toshihide Tanaka, Kostadin Karagiozov, and Yuichi Murayama.
    • Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Jikei University Kashiwa Hospital, Chiba, Japan. Electronic address: meatballnikudanngo@gmail.com.
    • World Neurosurg. 2018 Jun 1; 114: 144-150.

    BackgroundSurgical treatment of vertebral artery (VA)-thrombosed giant aneurysms requires achieving both obliteration of the parent artery to prevent bleeding and dome thrombectomy to relieve the brain stem from mass effect. To secure both proximal and distal control of complex VA aneurysms, the contralateral approach to the aneurysm might be a useful alternative, as previously described. We successfully treated a case of VA-thrombosed giant aneurysm in a new, original way by combining craniotomy (ipsilateral and contralateral) and the endovascular technique.Case DescriptionA 48-year-old man presented with a thrombosed giant aneurysm of the right VA compressing the brain stem. Treatment consisted of endovascular proximal ligation of the VA followed by 2-staged craniotomy for complete trapping of the aneurysm and intra-aneurysmal thrombectomy. The VA distal to the aneurysm was obliterated via contralateral craniotomy as only that provided adequate working space. Finally, intra-aneurysmal partial thrombectomy was performed through an ipsilateral craniotomy, which also made possible the obliteration of the eventually dangerous remaining vasa vasorum and additional proximal ligation of the VA.ConclusionsBased on pathologic and surgical anatomical characteristics, a combination of an endovascular procedure with 2-staged craniotomy for complete trapping, thrombectomy, and vasa vasorum obliteration could be considered a feasible way to treat VA-thrombosed giant aneurysms located ventral to the brain stem and have their distal neck portions/patent vessel beyond the midline toward the contralateral side.Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

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