World Neurosurg
-
Case Reports
Partial anterior petrosectomies for upper basilar artery trunk aneurysms: a cadaveric and clinical study.
Surgical clipping for upper basilar artery (BA) trunk aneurysms has become less common since the popularization of endovascular therapy. However, when endovascular therapy is not feasible, direct open surgery is still the treatment of choice. The anterior transpetrosal approach (ATP) is most often used to safely treat these aneurysms. We evaluate the feasibility of a modified partial anterior transpetrosal approach for the treatment of upper BA trunk aneurysms. ⋯ Modification and minimization of the conventional ATP provided sufficient exposure for the treatment of upper BA trunk aneurysms. Detailed anatomical knowledge obtained though cadaveric dissection facilitated development of this effective and less invasive approach.
-
To describe our designed protocol for the reconstruction of three-dimensional (3D) models applied to various endoscopic endonasal approaches that allows performing a 3D virtual dissection of the desired approach and analyzing and quantifying critical surgical landmarks. ⋯ The methodology for surgical training in the anatomic laboratory described in this article has proven to be very effective, producing a depiction of anatomic landmarks as well as 3D visual feedback that improves the study, design, and execution in various neurosurgical approaches. The Dextroscope as a virtual surgery simulation system can be used as a preoperative planning tool that can allow the neurosurgeon to perceive, practice reasoning, and manipulate 3D representations using the transsphenoidal perspective acquiring specifically visual information for endoscopic endonasal approaches to the skull base. The Dextroscope also can be used as an advanced tool for analytic purposes to perform different types of measurements between surgical landmarks before, during, and after dissection.
-
Aneurysms at the junction of the vertebral artery (VA) and posterior inferior cerebellar artery (PICA) are relatively rare. Their treatment is challenged by the diverse anatomy of the VA and PICA, close involvement of the PICA in the aneurysm neck, and scant space deep in the posterior fossa next to the cranial nerves, brain stem, and obstructing structures of the skull base. Computed tomography angiography (CTA) visualizes bony structures in addition to the vasculature, and being noninvasive and easily available, it can serve for planning microsurgical treatment. We analyzed the anatomy of PICA aneurysms imaged by CTA to promote planning the treatment. ⋯ Relation of PICA aneurysms to skull base structures is highly variable; the aneurysms can also be extracranial, or lie on the site of the skull contralateral to the origin of the parent artery. These anatomical variations demand meticulous study of the angiography in each individual case, especially before surgical treatment of the aneurysm.
-
Vasospasm is the leading source of neurological morbidity after aneurysmal subarachnoid hemorrhage. Our objective was to evaluate the impact of treatment modality on vasospasm, delayed cerebral infarction, and clinical deterioration caused by delayed cerebral ischemia (CD-DCI). ⋯ We demonstrate significantly lower rates of vasospasm and delayed infarction after endovascular coiling of ruptured aneurysms.
-
To describe surgical management with complete resection of patients with recurrent benign or malignant lesions involving the cavernous sinus after standard therapy with an emphasis on surgical indications and surgical technique. ⋯ Complete cavernous sinus resection is an option for patients with progressive or recurrent tumors after standard therapy. Extended survival can occur in some patients. The risks of surgery are considerable, and the underlying disease, age of the patient, and associated comorbidities should be considered when making the decision to operate. Surgery should be considered for oncologic resection of malignant tumors with limited extracranial disease or in patients with recurrent or progressive benign tumors. A key decision involves whether revascularization should be used with resection. Revascularization has been used in patients with inadequate vascular reserve as measured by balloon occlusion testing and patients with benign tumors and longer life expectancy.