Technical Description of the Medial and Lateral Anterior Temporal Approach for the Treatment of Complex Proximal Posterior Cerebral Artery Aneurysms

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• 作者：Felix Goehre¹ ; ² ; ^{fgoehre@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Hiroyasu Kamiyama¹ ; Kosumo Noda¹ ; Nakao Ota¹ ; Toshiyuki Tsuboi¹ ; Shiro Miyata¹ ; Takashi Matsumoto¹ ; Takeshi Yanagisawa¹ ; Sadahisa Tokuda¹ ; Rokuya Tanikawa¹
• 关键词：Aneurysm ; Anterior temporal approach ; Bypass ; Microsurgical technique ; PCA ; Posterior cerebral artery
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：86
• 期：Complete
• 页码：490-496
• 全文大小：1620 K

文摘

Posterior cerebral artery (PCA) aneurysms are often fusiform and associated with multiple intracranial aneurysms. A bypass procedure in combination with proximal occlusion or aneurysm trapping is considered to be effective for the treatment of patients with complex PCA aneurysms. Because of the deep, narrowed surgical corridor and the surrounding sensitive neuroanatomic structures, microsurgical procedures applied to the PCA are technically demanding. The authors present a technical report of a complex aneurysm formation located at the postcommunicating segment of the PCA (PCA-P2) treated via an anterior temporal approach.

Methods

A 68-year-old woman had an unruptured PCA-P2 aneurysm formation, which was discovered incidentally. The fusiform aneurysm shape of the distal aneurysm aggravated direct microsurgical and endovascular treatment. After an individual case discussion, the patient underwent a microsurgical clipping of the proximal P2 segment aneurysm and the distal PCA-P2 segment aneurysm was treated by trapping after the application of a superficial temporal artery (STA) to PCA-P2 bypass using an anterior temporal approach.

Results

Postoperative computed tomography angiography showed the exclusion of the proximal PCA-P2 aneurysm and an adequate flow from the STA to PCA-P2 bypass to the distal PCA segments. The patient showed a modified Rankin scale of 0 after follow-up at 1 and 3 months.

Conclusions

The anterior temporal approach is feasible for the microsurgical management of complex postcommunicating PCA aneurysms and the application of bypass procedures.