Aneurysms of the Posterior Cerebral Artery and Approach Selection in Their Microsurgical Treatment: Emphasis on the Appr
Aneurysms of the posterior cerebral artery (PCA) are infrequent and located in the central depth of the brain. Hence their optimal microsurgical management has not been discussed systematically, as institutions and/or neurosurgeons have only limited exper
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Abstract Aneurysms of the posterior cerebral artery (PCA) are infrequent and located in the central depth of the brain. Hence their optimal microsurgical management has not been discussed systematically, as institutions and/or neurosurgeons have only limited experience. The purpose of this communication is to report our considerations on this topic with emphasis on the selection of approaches by reviewing our 20 consecutive cases of PCA aneurysms out of more than 1,000 aneurysm patients seen over the past 15 years. Although the subtemporal approach appears to be prevalent in the literature, in our series we applied the pterional approach with or without selective extradural anterior clinoidectomy (SEAC) for P1, P1-P2 aneurysms, and either a selective amygdalohippocampectomy approach (SAHEA) or supracerebellar transtentorial approach (SCTTA) for P2 and P2-P3 aneurysms. Construction of an extracranial-intracranial EC-IC bypass, when necessary, in conjunction with parent artery occlusion or with trapping of aneurysms was adapted to selected approaches. Keywords PCA aneurysm · Approach · Selective amygdalohippocampectomy approach (SAHEA) · Supracerebellar transtentorial approach (SCTTA) · Extracranial-intracranial (EC-IC) bypass
Introduction Aneurysms of the posterior cerebral artery (PCA) are infrequent [3, 8] and located in the center of the brain, covered by the brain and bony structures of the skull. Accordingly, reports on this topic are rare, although Drake et al. published a pioneering report on 125 patients (59 non-giant aneurysms and 66 giant aneurysms) by using the subtemporal approach [3]. This approach, even in recent reports [13, 27], is considered standard, especially for aneurysms of the P2 segment. Only a limited number of authors have studied the approaches used to treat aneurysms of the PCA. Such approaches include, for example, the pterional approach for P1, P1-2 aneurysms, the subtemporal approach for P2 aneurysms and transoccipital interhemispheric approach for P3 aneurysms, as described by Yasargil in reviewing his 11 cases [19], or the transzygomatic approach described by Gerber et al. reporting on 2 cases [4]. We believe that appropriate approaches should take into account the locations of aneurysms and the swollen state of the brain in the acute stage of subarachnoid hemorrhage (SAH) with or without intracerebral hematoma (ICH) or intraventricular hematoma (IVH). This is why we are of the opinion that the selective amygdalohippocampectomy approach (SAHEA) [20, 24] or supracerebellar transtentorial approach (SCTTA) [23] should be considered for aneurysms of the P2, P2-P3 segment, especially in the acute stage of SAH.
Patients and Results
Y. Yonekawa () Neurochirurgie FMH, University of Zürich, Haldenbachstrasse 18, 8091 Zürich, Switzerland, Klinik im Park, Zürich, Switzerland and Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland e-mail: [email protected] P. Roth, J. Fandino, and H. Landolt Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
Twenty consecuti
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