Institutional Experience of Microsurgical Management in Posterior Circulation Aneurysm

Raghavendra Kumar Sharma; Ambuj Kumar; Yasuhiro Yamada; Riki Tanaka; Saurabh Sharma; Kyosuke Miyatani; Saeko Higashiguchi; Tsukasa Kawase; Srikanth Talluri; Yoko Kato

doi:10.4103/ajns.AJNS_69_20

Institutional Experience of Microsurgical Management in Posterior Circulation Aneurysm

Asian J Neurosurg. 2020 Aug 28;15(3):484-493. doi: 10.4103/ajns.AJNS_69_20. eCollection 2020 Jul-Sep.

Affiliations

¹ Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India.
² Department of Neurosurgery, N.S.C.B. Medical College, Jabalpur, Madhya Pradesh, India.
³ Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan.
⁴ Department of Neurosurgery, Max Hospital, New Delhi, India.
⁵ Department of Neurosurgery, SVIMS, Tirupati, Andhra Pradesh, India.

Abstract

Introduction: Posterior circulation aneurysm constitutes 15%-20% of all intracerebral aneurysms. With the advancement of endovascular techniques, the microsurgery for posterior circulation aneurysms has been pushed back a little. Even the International Subarachnoid Aneurysmal Trial gave support to the concepts of endovascular procedures, but microsurgical modality should not be discouraged. We present our institutional experience of microsurgical techniques on posterior circulation aneurysms.

Materials and methods: We performed a retrospective analysis of 37 patients of posterior circulation aneurysm from 2015 to 2019, referred to Bantane Hospital, Japan. We included all posterior circulation aneurysms such as basilar tip, basilar trunk, and vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysms, admitted and treated with clipping or bypass and trapping. We assessed the outcome as measured by modified Rankin Score (mRS), complications, and mortality.

Results: Out of 37 patients, 10 cases were a basilar tip, one case was the basilar trunk, and 26 cases were VA-PICA aneurysm. Intraoperatively, neuromonitoring, indocyanine green dye, dual-image videoangiography (DIVA), and neuro endoscope were used. Two patients of basilar tip aneurysm developed third cranial nerve paresis and six patients of VA-PICA aneurysm developed lower cranial nerve paresis which resolved spontaneously. All the patients were discharged with mRS of 0 or 1. No mortality was recorded in our study.

Conclusion: Microsurgical clipping of posterior circulation aneurysm is safe in unruptured aneurysm with a very low risk of mortality and morbidity under experienced hands. All postoperative complications in our study were transient and resolved with time with no residual deficits. Preoperative simulation, intraoperative neuromonitoring, DIVA, and neuro endoscope help achieve complete obliteration of aneurysmal sac and avoid complications.

Keywords: Basilar tip aneurysm; dual-image videoangiography; posterior circulation aneurysm; vertebral artery-posterior inferior cerebellar artery aneurysm.