Summary
This paper highlights two interesting cases of radial clipping of large aneurysms at the vertebro-basilar junction accompanied by a vascular anomaly, consisting of fenestration of the split basilar artery at its origin. Description of the inner and outer surface of the aneurysm were obtained pre-operatively, from analysis by 3D CT and 3D CT endoscopy of the form of the neck, parent vessels of the vertebral arteries on both sides, basilar artery and split basilar artery, as well as other details of branching. The neck exhibited a broad base in both cases. The height of the neck extended to the internal acoustic meatus, and it was possible to expose the circumference of the aneurysmal neck, peripheral basilar artery and both vertebral arteries proximally with an anterior transpetrosal approach. Based on the size of the aneurysm and the site being the anterior surface of the brain stem, clipping (consisting of interruption of the occluded portion and reconstruction of the parent vessels) was performed. In the first case it was achieved protecting the brain by hypothermia and barbiturates under deep hypothermia with extracorporal circulation, and in the second case, a state of circulatory arrest was used. This paper documents the report of two cases along with other cases treated so far.
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References
Ausman JI, Malik GM, Tomecek FJ, Adamson JR, Balakrishnan G, Serwin J, Lewis JW, Economopoulus G, Charbel FT (1993) Hypothermic circulatory arrest and the management of giant and large cerebral aneurysms. Surg Neurol 40: 289–298
Drake CG, Barr HWK, Coles JC, Gergely NF (1964) The use of extracorporal circulation and profound hypothermia in the treatment of ruptured intracranial aneurysm. J Neurosurg 21: 575–581
Drake CG (1979) The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26: 96–144
Guegan Y, Scaralsin JM, LeGuilcher C, Guillou L, Logeais Y, Pecker J (1985) Extracorporeal circulation with deep hypothermia and circulatory arrest in the treatment of intracranial aneurysms. Surg Neurol 24: 441–448
Hashi K, Nishikawa K, Shimotake K (1982) Transpetrosal combined supratentorial and infratentorial approach for midline vertebro-basilar aneurysms. Modern Neurosurgery 1: 442–448
Hori T, Tanabe M, Okamoto H, Numata H, Hokama Y, Watanabe T, Ishii T, Teraoka A (1994) Basilar artery trunk aneurysms-eight operative experiences and 2 autopsy findings. Surg Cereb Stroke 22: 495–504
Katada K, Anno H, Koga S,et al (1990) Three-dimensional angioimaging with helical scanning CT. Radiology 177 [Suppl]: 364
Kawase T, Toya S, Shiobara R (1985) Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63: 857–801
Kawano T, Mori K, Yokoyama H, Kaminogo M, Tustusumi K, Hishimura S (1992) Basilar artery trunk aneurysms approached through Trautmann's triangular space. Surg Cereb Stroke 20: 18–23
Kuyama H, Nagao S, Inomata S, Matsumoto Y, Umegaki O, Oguri K, Imawaki S (1995) A large thrombosed aneurysm arising from the right posterior cerebral artery (P2) treated with deep hypothermia and circulatory arrest. Surg Cereb Stroke 23: 93–98
Saito I, Sasaki T, Sano K (1980) Clipping of vertebral aneurysms by the transoral transclival approach. Med Chir (Tokyo) 20: 753–758
Salamon G, Huang YP (1976) Arteries of the vertebrobasilar system. Radiological anatomy of the brain. Springer, Berlin Heidelberg New York, pp 303–331
Sanders W, Sorek PA, Mehta BA (1993) Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies. AJNR 14: 675–680
Solomon RA (1994) Principles of aneurysms surgery: cerebral ischemic protection, hypothermia, and circulatory arrest. Clin Neurosurg 41: 351–363
Spetzler RF, Hadley MN, Rigamonti D, Carter LP, Raudzens PA, Shedd SA, Wilkinson E (1988) Aneurysms of the basilar artery treated with circulatory arrest, hypothermia, and barbiturate cerebral protection. J Neurosurg 68: 868–879
Sugita K, Kobayashi S, Takemae T (1987) Aneurysm basilar artery trunk. J Neurosurg 66: 500–505
Sundt TM Jr, Pluth JR, Gronert GA (1972) Excision of giant basilar aneurysm under profound hypothermia. Report of case. Mayo Clin Proc 47: 631–634
Swain JA, Anderson RV, Siegman MG (1993) Low-flow cardiopulmonary bypass and cerebral protection: a summary of investigations. Ann Thorac Surg 56: 1490–1492
Tanabe H, Kazuki S, Miyake H, Shiguma M, Shimizu K, Ohta T (1989) Transpetrosal-anterosigmoidal approach for vertebrobasilar union aneurysms: a case report. Surg Cereb Stroke 17: 40–43
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Kato, Y., Sano, H., Zhou, J. et al. Deep hypothermia cardiopulmonary bypass and direct surgery of two large aneurysms at the vertebro-basilar junction. Acta neurochir 138, 1057–1066 (1996). https://doi.org/10.1007/BF01412308
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DOI: https://doi.org/10.1007/BF01412308