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Can sectioning the posterior communicating artery be predicted with computed tomography angiography in the microsurgical clipping of basilar apex aneurysms?

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Microsurgical clipping is a viable option for managing high-riding basilar apex aneurysms (BAXs) using a transsylvian approach. Cutting the posterior communicating artery (PCoA) at the perforator-free zone provides sufficient exposure of BAX, although it is not always safe. The aim was to qualitatively predict sectioning of the interfering PCoA by using preoperative computed tomographic angiography (CTA).

Methods

A virtual trajectory from the lesser sphenoid wing to the neck of the aneurysm was simulated on CTA in 19 consecutive patients operated on BAX aneurysms from 2013 to 2018. The angles on CTA resembled the typical view through the extended pterional craniotomy. Next, the ipsilateral PCoA was tracked from the internal carotid to its end at the posterior cerebral artery in the trajectory.

Results

The opticocarotid and carotid-oculomotor window served as the corridors for entering the interpeduncular fossa in 16 patients (84.2%) and in 3 patients (15.8%), respectively. The PCoA was intentionally cut during nine surgeries and preserved in 10 of them. The PCoA was cut more often when positioned toward the cranial base and more medially in the corridor; both the Kernel density analysis and the data points representing the position of the PCoA supported this finding (p < 0.01). The CTA-based position of either ends of the PCoA in the trajectory did not differ between cut and not-cut groups (p = 0.19–0.96). Aneurysm projection, rupture, size, PCoA diameter, length, and other distances on CTA were not related to the sectioning of PCoA (p > 0.05).

Conclusions

The probability of PCoA sectioning is higher when the PCoA is positioned medially and closer to the cranial base. If the anatomical course of the PCoA is recognized beforehand, it can contraindicate surgery. Preoperative CTA-based planning facilitates the surgery of BAX aneurysms. Therefore, CTA can make microsurgical clipping planning more predictable for the neurosurgeon and safer for the patient.

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Authors and Affiliations

  1. Neurosurgery Department, Medical University of Gdansk, Dębinki 7, 80-952, Gdansk, Poland

    Tomasz Szmuda, Paweł Słoniewski, Jarosław Dzierżanowski & Kamil Siedlecki

  2. Student’s Scientific Circle, Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland

    Shan Ali & Alexandra Kamieniecki

Authors
  1. Tomasz Szmuda
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  2. Paweł Słoniewski
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  3. Shan Ali
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  4. Jarosław Dzierżanowski
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Correspondence to Tomasz Szmuda.

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Presentation at a conference: accepted for oral presentation in the upcoming WFNS Congress in Beijing, China, Sep 2019

This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Szmuda, T., Słoniewski, P., Ali, S. et al. Can sectioning the posterior communicating artery be predicted with computed tomography angiography in the microsurgical clipping of basilar apex aneurysms?. Acta Neurochir 162, 567–579 (2020). https://doi.org/10.1007/s00701-019-04138-2

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