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Neurosurgery for Cerebral Aneurysms

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PanVascular Medicine

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Abstract

The goal of cerebral aneurysm surgery is to prevent rupture or further enlargement of the aneurysm while at the same time preserving all normal vessels and minimizing injury to brain tissue and cranial nerves. This is usually accomplished by excluding the aneurysm from the circulation with a clip across the neck. Compared to coiling, the advantages of clipping are a higher rate of aneurysm obliteration, superior protection from rebleeding, as well as less need for follow-up and re-treatment due to a higher durability of clipping. In view of the higher morbidity associated with surgery itself, the principal challenge in aneurysm surgery is to clip the neck adequately without neck remnants and with minimum injury to the brain while preserving flow within the parent artery and avoiding obstruction of branching perforators. This chapter provides an overview of surgical considerations and operative techniques for microsurgical management of cerebral aneurysms at their most frequent localizations.

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Abbreviations

ACA:

Anterior cerebral artery

AcomA:

Anterior communicating artery

AICA:

Anterior inferior cerebellar artery

AIH:

Anterior interhemispheric approach for aneurysms of the distal anterior cerebral artery

Aneurysm clip:

Titanium clip with blades for microsurgical aneurysm obliteration

aSAH:

Aneurysmal subarachnoid hemorrhage

Asterion:

Junction of the parieto-occipital bone and the mastoid process of the temporal bone

DIND:

Delayed ischemic neurological deficit secondary to aneurysmal subarachnoid hemorrhage

Distal control:

Microsurgical dissection of the vessel segment distal to the aneurysm to permit temporary clipping

Far-lateral approach:

Infratentorial approach for aneurysms of the vertebrobasilar circulation

ICA:

Internal carotid artery

ICG:

Indocyanine green videoangiography for intraoperative assessment of vessel patency

Kawase approach:

Subtemporal approach described by Professor Kawase characterized by removal of the anterior aspect of the petrous bone for aneurysms of the distal part of the basilar artery

LSI:

Laser speckle imaging for intraoperative assessment of cortical perfusion

LSO:

Lateral supraorbital approach described by Professor Hernesniemi for aneurysms of the anterior circulation

MCA:

Middle cerebral artery

Microsurgery:

Neurosurgery with microsurgical instruments and the assistance of an operating microscope

PCA:

Posterior cerebral artery

PcomA:

Posterior communicating artery

PICA:

Posterior inferior cerebellar artery

Proximal control:

Microsurgical dissection of the vessel segment proximal to the aneurysm to permit temporary clipping

Pterion:

Junction of the frontotemporal-sphenoidal bone

Pterional approach:

Supratentorial approach described by Professor Yasargil for aneurysms of the anterior circulation

Saccular aneurysm:

Typical “berry”-shaped aneurysm

SCA:

Superior cerebellar artery

UIA:

Unruptured intracranial aneurysm

Vasospasm:

Radiographic and/or symptomatic narrowing of the proximal vasculature of the brain with the subsequent risk of ischemic stroke following aneurysmal subarachnoid hemorrhage

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Authors and Affiliations

  1. Department of Neurosurgery, Charité University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Nils Hecht M.D. & Prof. Dr. med. Peter Vajkoczy M.D.

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  1. Nils Hecht M.D.
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  2. Prof. Dr. med. Peter Vajkoczy M.D.
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Correspondence to Peter Vajkoczy M.D. .

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Editors and Affiliations

  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Hecht, N., Vajkoczy, P. (2014). Neurosurgery for Cerebral Aneurysms. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_103-1

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  • DOI: https://doi.org/10.1007/978-3-642-37393-0_103-1

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