Surgical Experience of Posterior Circulation Aneurysms: Clinical Analysis of 64 Cases

Han, Dae Hee; Oh, Chang Wan

Abstract

Surgical treatment of posterior circulation aneurysms are still challenging to the neurosurgeons, requiring highly skilled hands. During the past 10 years, the senior author(DH Han) operated upon 64 posterior circulation aneurysms. The number of the basilar bifurcation aneurysms(BBAA) were 31(48%), the posterior cerebral artery aneurysms(PCEAA) 7, the superior cerebellar artery aneurysms(SCAA) 10, the anterior inferior cerebellar aneurysms(AICAA) 3, the vertebro-basilar junction aneurysms(VBJA) 2, the vertebral artery aneurysms(VAA) 5 and the posterior inferior cerebellar artery aneurysms(PICAA) 6. The surgical approaches for BBAA, SCAA and PCEAA(proxinal to P4) were pterional route in 41 aneurysms and subtemporal in 4. Modified pterional approach was suitable for most of such aneurysms. For lower basilar trunk aneurysms(AICAA and VBJA), both far lateral suboccipital craniectomy and petrosal presigmoid approach had been tried and the presigmoid one seemed to be the choice of approach. The authors achieved aneurysmal neck clipping in the 48(75%) aneurysms, wrapping in other 8 and proximal clipping in the other 8. The operative mortality and morbidity were 6% and 17% each, which were comparable to the other series. Concerning surgical complications, transient oculomotor palsies were most frequent(38%), followed by transient hemiparesis, thalamic infarction, status epilepticus and peripheral infarction of the parent-arterial territory.