Microsurgical Treatment Of Posterior Circulation Aneurysm

ObjectiveThe ruptured of posterior circulation aneurysm is a life-threatening condition andcan lead to a high mortality and disability rate, both because of the depth of the lesionsite and the vicinity of thalamas, brainstem and important neurovascular structures.The microsurgical treatment of posterior circulation aneurysm is challenge toneurosurgeon. This article aims to discuss the microsurgical treatment of posteriorcirculation aneurysm by analyzing it’s clinical features, operation time, surgicalapproach and postoperative complications in detail.MethodsThe clinical features of24patients with posterior circulation aneurysm andaccepted the microsurgical treatment were summarized. They are admitted inDepartment of Neurosurgery of The First Affiliated Hospital of ZhengzhouUniversity from April2008to October2013． Our study sample comprised15maleand9female． An average age of56.3±19.4years(range2474yr)．All the patientsexamined by DSA or CTA and diagnosed with aneurysms of the posterior circulationdefinitely. The number of aneurysm is25, including11cases of basilar artery apexaneurysm,7cases of posterior communication artery aneurysm,3cases of posteriorinferior cerebellar artery aneurysm,2cases of superior cerebellar artery aneurysm,1cases of anterior inferior cerebellar artery aneurysm and1case of vertebral arterialdissecting aneurysm. All the patients accepted microsurgical treatment and dividedinto three groups by the time between first attack and surgery: early surgery group,mild surgery group and prolonged surgery group. Of24patients,16cases underwentearly operation (≤3days),3cases underwent mild operation (4~14days) and5 cases underwent prolonged operation (≥14days). The surgical approach includepterional approach, extensive pterional approach, infratemporal fossa approach,sub-occipital medline approach, retrosigmoid approach and posteriorinterhemispheric fissure approach. To the patients with basilar artery apex aneurysmabove dorsum sellae, we chose the surgical approach through simulating andexperimenting related date acquired by CTA. The treatment methods include clippingof the aneurysm, aneurysm isolation and angioplasty, After operation, Observingnearly the change of illness such as consciousness, pupillarychanges, vital signs andneurologic function.ResultsAll the patients examined by DSA or CTA and diagnosed with aneurysmsdefinitely. The surgical approach include3cases of pterional approach,3cases ofextensive pterional approach,12cases of sub-occipital medline approach,1case ofretrosigmoid approach and5cases of posterior interhemispheric fissure approach. Inthis group of25aneurysms,21aneurysms treated by clipping of the aneurysm,3cases of angioplasty and1case of aneurysm isolation.24cases were followed up for6months5years and evaluated by Glasgow Coma Scale (GCS). When leavinghospital, The good GCS rate of early surgery group is93.75%，mild surgery group is0and prolonged surgery group is50%. When comparing the early surgery group andmild surgery group and early surgery group and prolonged surgery group in pairs, thedifferences is striking（P<0.05）. The GCS were testified again6months after leavinghospital, When comparing the early surgery group and mild surgery group and earlysurgery group and prolonged surgery group in pairs, the differences is striking（P<0.05）. In this group after operation,3cases with hydrocephalus,3cases withCVS,2cases accompanied by electrolyte disorders,1case with postoperativetraumatic delayed intracranial hematoma and1case with cerebral-cardiac syndrome.All the postoperative complication were corrected successfully excepted for1casewith cerebral-cardiac syndrome and1case with brain stem ischemia cased bycerebrovascular spasm deterioration. ConclusionsAlthough DSA is the golden standard for diagnosing intracranial aneurysm, butskulls CTA is better than the former in some respects. CTA has the features such asfast, safe, with any angle imaging, less pain and can direct operative approach, it canprovide sufficient and necessary information to the diagnosis of the posteriorcirculation aneurysms.The good rate of early operation group is higher than mild surgery group andprolonged surgery group (P<0.05）. Early operation can reduce the mortality andmorbidity effectively of the patients with Hunt-Hess grade of Ⅰ～Ⅲ., patients withHunt-Hess grade of Ⅳc omplicated withcerebellar hemotoma or acute obstructivehydrocephalus is also expected to benefit.The operation of posterior circulation aneurysm is difficult to operate, the key tosuccessful cooperation includes choosing the correct operative approach and theskilled surgical techniques. The subtemporal approach is more suitable for basilarartery apex aneurysm above dorsum sellae than pterional approach on account ofshorter surgery distance and wider operative field, Strengthening the prevention andtreatment of postoperative complications can reduce mortality and morbidity andimprove Life quality.