Object: Surgical clipping of paraclinoid aneurysm, thrombosed large aneurysm, and/or
vertebral-basilar dissecting aneurysms can be very difficult and has relatively high
morbidity. We describe our experience using skull base and bypass technique and discuss
the advantages and its pitfalls. Patients and Methods: We retrospectively reviewed
medical charts of 22 consecutive patients with complex aneurysmal lesions underwent
skull base and/or bypass techniques between March 2012 and April 2017. Results: There were 5 patients with paraclinoid or internal carotid artery (ICA) aneurysm
underwent modified extradural temporopolar approach with mini-peeling of the dura
propria with suction decompression, 3 patients with ICA aneurysm underwent intradural
anterior clinoidectomy, 12 patients with vertebral dissecting aneurysm through transcondylar
fossa approach (6 patients underwent occipital artery-posterior inferior cerebellar
artery [OA-PICA] bypass), 1 patients with vertebral artery dissection underwent superficial
temporal artery-superior cerebellar artery and OA-PICA bypass through posterior transpetrosal
approach, 1 patient with arteriovenous fistula at the ventral side of the craniovertebral
junction through extremely far lateral approach. Surgical outcome was good recovery
in 10 patients, moderate disability in 4, severe disability in 4, vegetative state
in 2, and dead is 2 patients. The favorable outcome was 63.6%, and poor outcome was
36.4%, which showed poor grade subarachnoid hemorrhagic patients. No patient suffered
any complication related to re-rupture and/or incomplete clipping. Conclusion: Skull base technique, which can create a wide and shallow operative space, allowed
us to improve surgical outcome and to reduce the risk of intraoperative neurovascular
injury for surgical treatment of deeply located complex aneurysms.
Key-words:
Giant aneurysm - ruptured aneurysm - skull base - subarachnoid hemorrhage
