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Retractorless combined pterional and interhemispheric approach to achieve proximal control in pericallosal artery aneurysm: how I do it

  • How I Do it - Vascular Neurosurgery - Aneurysm
  • Published:
Acta Neurochirurgica Aims and scope

Abstract

Background

Pericallosal artery aneurysms differ from other cerebral aneurysms for the difficulty in establishing proximal vascular control during surgical clipping. A frontomedial craniotomy with combined pterional and interhemispheric approach allows obtaining a better proximal control.

Materials and methods

We present our surgical technique to achieve a proximal vessel control in pericallosal artery aneurysm clipping using a combined pterional and interhemispheric approach through frontomedial craniotomy. This surgical technique is illustrated by an intraoperative video.

Conclusion

Proximal control for pericallosal artery aneurysm clipping can be challenging. In selected cases, a single craniotomy allows performing two approaches and obtaining a safer proximal control for surgical clipping.

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Abbreviations

ACA:

Anterior cerebral artery

AComA:

Anterior communicating artery

DSA:

Digital subtraction angiography

EEG:

Electroencephalogram

ICA:

Internal carotid artery

MEPs:

Motor evoked potentials

MCA:

Middle cerebral artery

PeA:

Pericallosal artery

CMA:

Callosomarginal artery

PCA:

Posterior cerebral artery

SSEPs:

Somato-sensory evoked potentials

SSS:

Superior sagittal sinus

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland

    Sara Bonasia & Thomas Robert

  2. University of Southern Switzerland, USI, Via Tesserete 46, 6900, Lugano, Switzerland

    Sara Bonasia & Thomas Robert

Authors
  1. Sara Bonasia
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  2. Thomas Robert
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Corresponding author

Correspondence to Sara Bonasia.

Ethics declarations

The patient gave his informed consent for the redaction and publication of the paper and the intraoperative video.

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

Electronic Supplementary Material

Intraoperative video of pterional-paramedian craniotomy to perform combined trans-Sylvian interhemispheric approach to clip middle cerebral artery and pericallosal artery aneurysms. This is the case of a 59-year-old patient, under antiplatelet treatment for ischemic cardiopaty and known for high blood pressure, hypercholesterolemy, obesity, and familiar history of aneurysmal subarachnoidal haemorrhage (father at the age of 40 years old). The patient underwent CT scan after seizure for severe hyponatremia. The CT scan showed incidentally a 5 mm aneurysm of the right anterior pericallosal artery, located at the bifurcation between the pericallosal and callosomarginal arteries, and a 4 mm aneurysm at the right middle cerebral artery bifurcation oriented superiorly. Considering the age of the patients and the vascular risk factors and the familiar hystory, we decided to treat both the aneurysms via a combined pterional-interhemispheric approach. The pre and post operative DSA images and each phase of surgery are presented and described in the video by the author (MP4 32940 kb)

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Bonasia, S., Robert, T. Retractorless combined pterional and interhemispheric approach to achieve proximal control in pericallosal artery aneurysm: how I do it. Acta Neurochir 163, 2733–2738 (2021). https://doi.org/10.1007/s00701-021-04782-7

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  • DOI: https://doi.org/10.1007/s00701-021-04782-7

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