Surgical clipping of vertebral and basilar artery aneurysms

Abstract

Objective To study an effective method for clipping vertebral and basilar artery aneurysms. Method There were 26 patients with 28 aneurysms of vertebral and basilar arteries. Aneurysms ruptured in 9 patients,the aneurysms in 16 patients were located in basilar artery including two aneurysms in one patient,and 10 aneurysms were located in vertebral artery including bilateral vertebral artery aneurysms in one patient and vertebral AVMs in one patient. Pterional approach underwent in 5 patients with basilar tip aneurysms,orhitozygomatic approach in 5 patients with basilar tip aneurysms and 2 patients with the upper basilar aneurysms, combination of presigmoid with far-lateral approach in 4 patients with mid basilar aneurysms. Of 10 patients with aneurysms of vertebral arteries, combination of far lateral with transpetrosal approaches were performed in 4 patients and combination of far lateral with condylar approaches in 6 patients. In 11 patients with bypass grafts because of the likehood of prolonged temporary occlusion or possibility of intraoperative parent artery sacrifice, the internal carotid artery to P2 segment of posterior cerebral artery bypass were performed in 2 patients, the external carotid artery to P2 segment of posterior cerebral artery bypass were performed in 4 patients, cervical vertebral to cranial vertebral artery bypass in 2 patients,and occipital to PICA bypass in 3 patients. Results There were back to normal life without neurological deficits after surgery in 9 patients with basilar tip aneurysms, 5 patients with basilar trunk aneurysms,and 10 patients with vertebral artery aneurysms. Total good outcome reached 24 (92%) patients after surgery. One patient need assistant for his daily life related to severe neurological deficits after surgery, one patient with basilar trunk aneurysm die of brain stem ischemia from the perforating arteries occlusion 20 days after surgery. Conclusions The selection of proper cranial base approaches should be benefit to obtain an adequate operative space for clipping of vertebrobasilar aneurysms. The adjunctive use of graft bypass may be till required to avoid parent and major branch occlusion during protracted temporary clipping of the parent artery and the sacrifice of either the parent vessel or one of the major branches for management of a complex intracranial aneurysm. Key words: Vertebrobasilar artery;  Intracranial aneurysm;  Surgical procedures,operative