Basilar artery trunk aneurysm clipping via keyhole retrosigmoid approach with endoscopic assistance (clinical case and literature review)
R. S. Dzhindzhikhadze,
R. L. Kambiev,
A. V. Polyakov,
G. Yu. Strakhov,
A. D. Zaitsev,
I. O. Bogdanovich https://doi.org/10.56618/2071-2693_2023_15_3_145
Abstract
Despite the increasing number of endovascular interventions for aneurysms of the basilar artery every year, a certain frequency of adverse outcomes remains. The possibilities of cerebral aneurysms surgery have expanded due to endoscopic assistance, which making it possible to minimize the size of approaches without changing the width of microsurgical corridors.
We present a case of successful clipping basilar artery trunk aneurysm via keyhole retrosigmoid approach supplemented with endoscopic assistance.
This clinical case demonstrates the possibility of successful clipping of a basilar artery trunk aneurysm without resorting to a wide approach, but with optimal visualization of the neck and dome before and after clipping. Keyhole approaches combined with endoscopic assistance can be an alternative to both traditional approaches and endovascular coiling.
About the Authors
R. S. Dzhindzhikhadze
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Dzhindzhikhadze Revaz Semenovich
61/2, Schepkina st., Moscow, 129110, Russia
R. L. Kambiev
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Kambiev Renat Leonidovich
61/2, Schepkina st., Moscow, 129110, Russia
A. V. Polyakov
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Polyakov Andrey Viktorovich
61/2, Schepkina st., Moscow, 129110, Russia
G. Yu. Strakhov
Tula City Clinical Emergency Hospital n. a. D. Y. Vanykin
Russian Federation
Russian Federation
Strakhov Grigoriy Yurievich
13, Pervomayskaya st., Tula, 300034, Russia
A. D. Zaitsev
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Zaitsev Andrew Dmitrievich
61/2, Schepkina st., Moscow, 129110, Russia
I. O. Bogdanovich
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Bogdanovich Igor’ Olegovich
61/2, Schepkina st., Moscow, 129110, Russia
References
1. Inoue Y, Mikami J, Omiya N, Okawara S. Subtemporal transpetrosal approach to ruptured midbasilar trunk aneurysm. Skull Base Surg. 1992;2(2):98–102. https://doi.org/10.1055/s‑2008–1057118
2. Locksley HB. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V part 1 Natural history of subarachnoid hemorrhage intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study. J Neurosurg. 1966;25:219–239. https://doi.org/10.3171/jns.1966.25.2.0219
3. Kukanov KK, Tastanbekov MM, Olyushin VE, Pustovoi SV, Pryanikov MV. Meningiomas of the foramen magnum: a review of the literature and a case report. Russian Journal of Neurosurgery. 2015;7(1):62–72. (In Russ.). EDN: AYGUHH
4. Nakabayashi K, Negoro M, Itou Y, Ichihara K. Endovascular Approach vs Microsurgical Approach for Posterior Circulation Aneurysms. Interv Neuroradiol. 1997;3(suppl 2):171–6. https://doi.org/10.1177/15910199970030S236
5. Krylov VV, Dashyan VG, Vinokurov AG. Microsurgery of cerebral aneurysms. Moscow: ABV-press, 2022. (In Russ.). EDN: IVKOCL
6. Lozier AP, Kim GH, Sciacca RR, Connolly ES Jr, Solomon RA. Microsurgical treatment of basilar apex aneurysms: perioperative and long-term clinical outcome. Neurosurgery. 2004;54(2):286–96; discussion 296–9. https://doi.org/10.1227/01.neu.0000103222.13642.00
7. Qu S, Lv X, Wu Z. Clinical outcomes of basilar artery aneurysms. Neuroradiol J. 2009;22(2):228–38. https://doi.org/10.1177/197140090902200215
8. Winkler EA, Lee A, Yue JK, Raygor KP, Rutledge WC, Rubio RR, Josephson SA, Berger MS, Raper DM S, Abla AA. Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era. Acta neurochirurgica. 2021;163:1527–1540. https://doi.org/10.1007/s00701‑021‑04803‑5
9. Fiorella D, Hsu D, Woo HH, Tarr RW, Nelson PK. Very late thrombosis of a pipeline embolization device construct: case report. Neurosurgery. 2010;67(suppl 3): 313–4; discussion 314. https://doi.org/10.1227/01.NEU.0000383875.08681.23
10. van Rooij WJ, Sluzewski M. P erforator infarction after placement of a pipeline flow-diverting stent for an unruptured A1 aneurysm. AJ NR Am J Neuroradiol. 2010;31(4):43–4. https://doi.org/10.3174/ajnr.A2034
11. Kato Y, Sano H, Behari S, Kumar S, Nagahisa S, Iwata S, Kanno T. Surgical clipping of basilar aneurysms: relationship between the different approaches and the surgical corridors. Minim Invasive Neurosurg. 2002;45(3):142–5. https://doi.org/10.1055/s‑2002–34351
12. Spetzler RF, Kalani Y, Nakaji P. Neurovascular Surgery. 2nd ed. Thieme Medical Publishers; 2015. https://doi.org/10.1055/b‑0035–122313
13. Drake CG. Bleeding aneurysms of the basilar artery. Direct surgical management in four cases. J Neurosurg 1961;18:230–238. https://doi.org/10.3171/jns.1961.18.2.0230
14. Drake CG. The surgical treatment of aneurysms of the basilar artery. J Neurosurg 1968;29:436–446. https://doi.org/10.3171/jns.1968.29.4.0436
15. Sugita K, Kobayashi S, Takemae T, Tada T, Tanaka Y. Aneurysms of the basilar artery trunk. J Neurosurg. 1987;66(4):500–5. https://doi.org/10.3171/jns.1987.66.4.0500
16. Mizoi K, Yoshimoto T, Takahashi A, Ogawa A. Direct clipping of basilar trunk aneurysms using temporary balloon occlusion. J Neurosurg. 1994;80(2):230–6. https://doi.org/10.3171/jns.1994.80.2.0230
17. Taki W, Nakahara I, Sakai N, Irie K, Murao K, Ohkata N, Tanaka M, Kikuchi H. L arge and giant middle to lower basilar trunk aneurysms treated by surgical and interventional neuroradiological methods. Neurol Med Chir (Tokyo). 1998;38(12):826–34; discussion 834–5. https://doi.org/10.2176/nmc.38.826
18. Terasaka S, Itamoto K, Houkin K. Basilar trunk aneurysm surgically treated with anterior petrosectomy and external carotid artery-toposterior cerebral artery bypass: technical note. Neurosurgery. 2002;51(4):1083–7; discussion 1087–8. https://doi.org/10.1097/00006123‑200210000‑00044
19. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809–17. https://doi.org/10.1016/S 0140–6736 (05) 67214‑5
20. Spetzler RF, McDougall CG, Albuquerque FC, Zabramski JM, Hills NK, Partovi S, Nakaji P, Wallace RC. The Barrow Ruptured Aneurysm Trial: 3-year results. J Neurosurg. 2013;119(1):146–57. https://doi.org/10.3171/2013.3.JNS 12683
21. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RDJr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner J C. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10. https://doi.org/10.1016/s0140–6736 (03) 13860‑3
22. Sanai N, Tarapore P, Lee AC, Lawton MT. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgery. 2008;62(6):1236–49; discussion 1249–53. https://doi.org/10.1227/01.neu.0000333295.59738.de
23. Sekhar LN, Tariq F, Morton RP, Ghodke B, Hallam DK, Barber J, Kim LJ. Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients. Neurosurgery. 2013;72(2):284–98; discussion 298–9. https://doi.org/10.1227/NEU.0b013e3182797952
24. Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J. Endovascular Treatment of Intracranial Unruptured Aneurysms: Systematic Review and Meta-Analysis of the Literature on Safety and Efficacy. Radiology. 2010;256:887–97. https://doi.org/10.1148/radiol.10091982
25. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A , Lamoureux J, Chagnon M, Roy D. Long-Term Angiographic Recurrences After Selective Endovascular Treatment of Aneurysms With Detachable Coils. Stroke. 2003;34:1398–403. https://doi.org/10.1161/01.STR.0000073841.88563.E 9
26. Lecler A, Raymond J, Rodriguez-Régent C, Shareef FA, Trystram D, Godon-Hardy S, Hassen WB, Meder JF, Oppenheim C, Naggara ON. Intracranial Aneurysms: Recurrences More than 10 Years after Endovascular Treatment-A Prospective Cohort Study, Systematic Review, and Meta-Analysis. Radiology 2015;277:173–80. https://doi.org/10.1148/radiol.2015142496
27. Soize S, Gawlitza M, Raoult H, Pierot L. Imaging Follow-Up of Intracranial Aneurysms Treated by Endovascular Means: Why, When, and How? Stroke. 2016;47(5):1407–12. https://doi.org/10.1161/STROKEAHA.115.011414
28. Lanzino G, Murad MH, d’Urso PI, Rabinstein AA. Coil embolization versus clipping for ruptured intracranial aneurysms: a meta-analysis of prospective controlled published studies. AJ NR Am J Neuroradiol. 2013;34(9):1764–8. https://doi.org/10.3174/ajnr.A3515
29. Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, Shi X, Tang Y, Peng Y. Clipping versus coiling for ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke. 2013;44(1):29–37. https://doi.org/10.1161/STROKEAHA.112.663559
30. Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Nakaji P, Karis JP , Wallace RC. Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2019;132(3):771–776. https://doi.org/10.3171/2018.8.JNS181846
31. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR. CARAT Investigators. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARA T) study. Stroke. 2008;39(1):120–5. https://doi.org/10.1161/STROKEAHA.107.495747
32. Munich SA, Cress MC, Rangel-Castilla L, Sonig A, Ogilvy CS, Lanzino G, Petr O, Mocco J, Morone PJ, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI. Neck Remnants and the Risk of Aneurysm Rupture After Endovascular Treatment With Coiling or Stent-Assisted Coiling: Much Ado About Nothing? Neurosurgery. 2019;84(2):421–427. https://doi.org/10.1093/neuros/nyy056
33. Darflinger R, Thompson LA, Zhang Z, Chao K. R ecurrence, retreatment, and rebleed rates of coiled aneurysms with respect to the Raymond-Roy scale: a meta-analysis. J Neurointerv Surg. 2016;8(5):507–11. https://doi.org/10.1136/neurintsurg‑2015–011668
34. Giannotta SL, Maceri DR. Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms. Technical note. J Neurosurg. 1988;69(3):461–6. https://doi.org/10.3171/jns.1988.69.3.0461
35. Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg. 1985;63(6):857–61. https://doi.org/10.3171/jns.1985.63.6.0857
36. Motoyama Y, Ohnishi H, Koshimae N, Kanemoto Y, Kim YJ, Yamada T, Kobitsu K. D irect clipping of a large basilar trunk aneurysm via the posterior petrosal (extended retrolabyrinthine presigmoid) approach — case report. Neurol Med Chir (Tokyo). 2000;40(12):632–6. https://doi.org/10.2176/nmc.40.632
37. Seifert V. Direct surgery of basilar trunk and vertebrobasilar junction aneurysms via the combined transpetrosal approach. Neurol Med Chir (Tokyo). 1998;38(suppl):86–92. https://doi.org/10.2176/nmc.38.suppl_86
38. Fischer J, Mustafa H. Endoscopic-guided clipping of cerebral aneurysms. Br J Neurosurg. 1994;8(5):559–65. https://doi.org/10.3109/02688699409002948
39. Perneczky A, Boecher-Schwarz HG. Endoscope-assisted microsurgery for cerebral aneurysms. Neurol Med Chir (Tokyo). 1998;38(suppl):33–4. https://doi.org/10.2176/nmc.38.suppl_33
40. Kato Y, Sano H, Nagahisa S, Iwata S, Yoshida K, Yamamoto K, Kanno T. Endoscope-assisted microsurgery for cerebral aneurysms. Minim Invasive Neurosurg. 2000;43(2):91–7. https://doi.org/10.1055/s‑2000–12260
41. Kalavakonda C, Sekhar LN, Ramachandran P, Hechl P. Endoscopeassisted microsurgery for intracranial aneurysms. Neurosurgery. 2002;51(5):1119–26; discussion 1126–7. https://doi.org/10.1097/00006123‑200211000‑00004
42. Galzio RJ, Di Cola F, Raysi Dehcordi S, Ricci A, De Paulis D. Endoscope-assisted microneurosurgery for intracranial aneurysms. Front Neurol. 2013;4:201. https://doi.org/10.3389/fneur.2013.00201
43. Peris-Celda M, Da Roz L, Monroy-Sosa A, Morishita T, Rhoton AL Jr. Surgical anatomy of endoscope-assisted approaches to common aneurysm sites. Neurosurgery. 2014;10(suppl1):121–44; discussion 144. https://doi.org/10.1227/NEU.0000000000000205
44. Dzhindhikhadze RS, Dreval ON, Lazarev VA, Kambiev RL, Bogdanovich IO. Transciliary miniorbitozygomatic keyhole approach to the upper basilar artery aneurysm. Clinical case and review of the literature. Russian Journal of Neurosurgery. 2017; 9(1):69–74. (In Russ.). EDN: LGIPTF
45. Dzhindzhikhadze RS, Dreval' ON, Lazarev VA, Poliakov AV, Kambiev RL, Davudov AM. Endoscope-assisted keyhole approach in cerebral aneurysm surgery. Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko. 2018;82(4):38–4. (In Russ.) https://doi.org/10.17116/neiro201882438.
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For citations:
Dzhindzhikhadze R.S., Kambiev R.L., Polyakov A.V., Strakhov G.Yu., Zaitsev A.D., Bogdanovich I.O. Basilar artery trunk aneurysm clipping via keyhole retrosigmoid approach with endoscopic assistance (clinical case and literature review). Russian Neurosurgical Journal named after Professor A. L. Polenov. 2023;15(3):145-151. (In Russ.) https://doi.org/10.56618/2071-2693_2023_15_3_145
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