Posterior Circulation Aneurysm Surgery

Oh, Chang Wan; Han, Dae Hee

Abstract

Surgical treatment of posterior circulation aneurysms are still challenging to the neurosurgeons, requiring highly skilled hands. Patients with intracranial aneurysms operated on from January 1984 to January 2003 have been reviewed retrospectively. During that period 104 patients with 110 posterior circulation aneurysms underwent operation in our institute. Among them 47 patients had 49 aneurysms at the basilar bifurcation. The posterior cerebral artery aneurysms (PCEAA) 11, the superior cerebellar artery aneurysms (SCAA) 18, the anterior inferior cerebellar aneurysms (AICAA) 6, the vertebral artery aneurysms (VAA) 8 and the posterior inferior cerebellar artery aneurysms (PICAA) 18. The surgical approaches for BBAA, SCAA and PCEAA (proximal to P4) were pterional route in 70 aneurysms and subtemporal in 4. Modified pterional approach was suitable for most of such aneurysms. For lower basilar trunk aneurysms (AICAA and VBJA), both far lateral suboccipital craniectomy and petrosal presigmoid approach had been tried and the presigmoid one seemed to be the choice of approach. The author achieved aneurysmal neck clipping in the 82 (73%) aneurysms, wrapping in other 15 and proximal clipping in the other 13. The operative mortality and morbidity were 6% and 17% each, which were comparable to the other series. Concerning surgical complications, transient oculomotor palsies were most frequent (38%), followed by transient hemiparesis, thalamic infarction, status epilepticus and peripheral infarction of the parent-arterial territory.