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KMID : 0857020020170010085
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Kosin Medical Journal
2002 Volume.17 No. 1 p.85 ~ p.92
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Selection of the Surgical Approach of the Aneurysms around the Vertebrobasilar Junction New Surgical Option Based on Angiogram
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Kim Do-Heon
Kim Han-Kyu
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Abstract
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Background : Surgical approaches to the aneurysms located at the lower basilar trunk, vertebrobasilar junction and vertebral artery are challenging and skull base approaches are mandatory. However, selecting a skull base approach for aneurysms at these locations can be difficult due to the variations in the locations of the portions of the vertebrobasilar artery in reference to bony landmarks. Although the intermeatal line and/or the K lines are good tools in the selection of surgical approach, these are too specific for full proximal and distal control. Objective This study was made it easy the selection of surgical approach in complex and variable posterior circulation aneurysms. We suggest new surgical option based on angiogram and evaluate the usefulness of our new wide skull base approach.
Materials and Methods : We applied our protocol to 10 SAH patients with aneurysms around VBJ. We employed the preservative petrosectomy for low basilar artery aneurysms, in which all the petrose bone was removed while the facial nerve, labyrinth and cochlea were preserved. Extreme lateral transcondylar and far lateral transcondylar approach were applied to the aneurysms locating from the VBJ to the origin of PICA and segments of vertebral artery from the origin of PICA and below, respectively.
Results : 3PICA-VA junction 1 vertebral, and 1 AICA-BA junction saccular aneurysms were clipped and 3 vertebral artery dissections were trapped or coated. 1 AICA-BA junction aneurysm was coated and the other one was exposed but could not be clipped because it was completely embedded in the brain stem. After the operation, 8 patients were in excellent conditions but 2 patients died.
Conclusion : Our new approach to the aneurysms around the VBJ may serve as another surgical option.
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KEYWORD
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Surgical Approach, Aneurysm, Vertebrobasilar
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