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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 321-326
DOI: 10.1055/s-0044-1786704
Case Report

Microneurosurgery for Ruptured Aneurysm of Distal Intracranial Vertebral Artery: A Case Report

Tushar V. Soni
1   Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
,
Shreyansh Patel 
1   Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
,
Varshesh Shah
1   Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
,
Sandip Singh
1   Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
,
Nirav Shah
1   Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
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Abstract

The International Subarachnoid Aneurysm Trial led to a shift from clipping to endovascular coiling as the primary therapy for cerebral aneurysm particularly in the management of posterior circulation aneurysm. However, endovascular therapy is often unavailable in low-resource settings, emphasizing the importance of maintaining surgical skill sets in resource-poor countries. This article presents a detailed case report on the successful microneurosurgical management of a 65-year-old female with a history of headache and weakness with past history of hypertension and a right posterior cerebral artery territory infarct who was diagnosed with a ruptured aneurysm situated within the intracranial vertebral artery. Patient was operated with the far lateral approach and clipping of the aneurysm. This case report elucidates the intricate surgical techniques employed, and the challenges neurosurgeons encountered in treating posterior circulation intracranial aneurysms, particularly those with ruptured complications. The aneurysms' intricate anatomy and increased rupture risk necessitate a meticulous microneurosurgical approach. The severity of subarachnoid hemorrhage from ruptured aneurysms increases morbidity and mortality rates.

Keywords

vertebral artery - subarachnoid hemorrhage - microneurosurgery - endovascular coiling - far lateral approach


Publication History

Article published online:
09 May 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bonneville F, Sourour N, Biondi A. Intracranial aneurysms: an overview. Neuroimaging Clin N Am 2006; 16 (03) 371-382 , vii
    CrossrefPubMedGoogle Scholar
  • 2 Ausman JI, Sadasivan B. Posterior inferior cerebellar artery vertebral artery aneurysms. In: Apuzzo MLJ. ed. Brain Surgery: Complication Avoidance and Management. New York: Churchill Livingstone; 1993: 1879-1894
    Google Scholar
  • 3 Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 1997; 28 (03) 660-664
    CrossrefPubMedGoogle Scholar
  • 4 Schievink WI, Wijdicks EF, Parisi JE, Piepgras DG, Whisnant JP. Sudden death from aneurysmal subarachnoid hemorrhage. Neurology 1995; 45 (05) 871-874
    CrossrefPubMedGoogle Scholar
  • 5 Day DJ, Giannotta SL. Surgical management of vertebral-PICA aneurysms. In: Schmidek HH, Sweet WH. eds. Operative Neurosurgical Techniques. Philadelphia: WB Saunders Company; 1995: 1103-1111
    Google Scholar
  • 6 Kurokawa Y, Okamura T, Watanabe K. Transcerebellar thrombectomy for the successful clipping of thrombosed giant vertebral artery-posterior inferior cerebellar artery aneurysm: case report. Surg Neurol 1990; 33 (03) 217-220
    CrossrefPubMedGoogle Scholar
  • 7 Nichols DA, Brown Jr RD, Thielen KR, Meyer FB, Atkinson JL, Piepgras DG. Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg 1997; 87 (03) 374-380
    CrossrefPubMedGoogle Scholar
  • 8 Luther E, McCarthy DJ, Brunet M-C. et al. Treatment and diagnosis of cerebral aneurysms in the post-International Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes. J Neurointerv Surg 2020; 12 (07) 682-687
    CrossrefPubMedGoogle Scholar
  • 9 Madsen JR, Heros RC. Giant peripheral aneurysm of the posterior inferior cerebellar artery treated with excision and end-to-end anastomosis. Surg Neurol 1988; 30 (02) 140-143
    CrossrefPubMedGoogle Scholar
  • 10 Heros RC. The far lateral inferior suboccipital approach. In: Wilkins RH, Rengachary SS. eds. Neurosurgery. New York: McGraw-Hill; 1996: 2357-2360
    Google Scholar
  • 11 Lai L, Morgan KM. Surgical management of posterior circulation aneurysms: defining the role of microsurgery in contemporary endovascular era. In: Signorelli F. ed. Explicative Cases of Controversial Issues in Neurosurgery. . Great Portland Street: London, W1W 5PF, United Kingdom. ISBN: 978–953–51–0623–4; 2012
    Google Scholar
  • 12 Molyneux AJ, Kerr RSC, Birks J. et al; ISAT Collaborators. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009; 8 (05) 427-433
    CrossrefPubMedGoogle Scholar
  • 13 Tsianaka E, Al-Shawish A, Potapov A, Fountas K, Spyrou M, Konovalov N. Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis. Chin Neurosurg J 2019; 5: 16
    CrossrefPubMedGoogle Scholar