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KMID : 1005420220240010073
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Journal of Cerebrovascular and Endovascular Neurosurgery
2022 Volume.24 No. 1 p.73 ~ p.78
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Endoport-assisted microsurgical treatment for a ruptured posterior cerebral artery aneurysm: A technical note
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Gomez-Amador Juan Luis
Sangrador-Deitos Marcos Vinicius
Uribe-Pacheco Rodrigo
Guinto-Nishimura Gerardo Yoshiaki
Mondragon-Soto Michel Gustavo
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Abstract
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Posterior Cerebral Artery aneurysms are scarce, yet its territory is frequently associated to large and giant aneurysms. Treatment is mostly a binary option between microsurgical clipping and endovascular coiling. Hybrid approaches are an option too, whereas innovation with less frequent techniques such as endoscope-controlled and endoscope-assisted procedure may provide a safer surgical approach with same successful results. Hereby we report a case of a 53 years old male examined at the ER after presenting generalized seizures and altered state of consciousness. Upon arrival, neurological evaluation revealed homonymous right hemianopia. Computed tomography (CT) scan revealed a subarachnoid hemorrhage and left parieto-occipital intraparenchymal hemorrhage with intraventricular extension; computed tomography angiogram (CTA) revealed an aneurysm at the left posterior cerebral artery (PCA) in its P4 segment. We performed a vascular exploration with drainage of the occipital and intraventricular hematoma through a single endoscopic port through transulcal approach guided by neuronavigation, in addition to clipping and aneurysmectomy. The combination of microsurgical clipping with previous Endoport-guided endoscopic procedure may be a surgical-operative option that not only may facilitate the approach to the desired lesion, but also provides a safer surgical scenario.
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KEYWORD
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Aneurysm, Endoscopic neurosurgery, Aneurysm clipping, Endoport, Vascular neurosurgery, Technical note
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