A-106. Microneurosurgery in Cerebral Aneurysms
Yutaka InabaYoshiharu FUKUSHIMANaoya TACHIBANAUmeo ItoA KamisasaKiyohide TachibanaTsukasa FujimotoShin TomitaKikuo Ohno
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Purpose: Endoscope-assisted microsurgery (EAM) has been routinely used in our department for the treatment of cerebral aneurysm. We revised a series of 132 consecutive surgical procedures to evaluate the efficacy of EAM.
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We describe our experiences with surgical clipping of 17 large aneurysms. The location of these aneurysms were 7ICAs (including 2 IC-ophthalamic non-ruptured cases), 7MCAs, 2ACAs, and 1BA. The postoperative outcome was GR, 6; MD, 5; SD, 3; D, 3. Three of 6 poor outcome cases were IC aneurysm. A total of 34 clips were used for clipping (average 2 clips in each case), and fenestrated clips were particularly useful in such cases. The causes of poor outcome were operative procedure in 3, spasm in 2, and primary brain damage in 1. In the preoperative examination, 3DCT virtual endoscopy was useful for a successful clipping.To improve the postoperative outcome for large aneurysms, prevention of premature rupture and an optimal obliteration of aneurysm with the preservation of afferent and efferent arteries as well as perforating vessels are important.
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Abstract The advent of flow diverter (FD) stents has apparently reduced the role of microneurosurgery for paraclinoid aneurysms despite sparse high-quality evidence about their long-term effects. The present study critically reviews the overall results of a microneurosurgical series of 57 paraclinoid aneurysms. Of these aneurysms, 47.4% were regular in size while 19.3 were giant. Barami type I was predominant. In 21 aneurysms a hemorrhagic onset occurred. Pterional approach with intradural anterior clinoidectomy was preferred by far. Clipping was possible in 91.2% of aneurysms and a high-flow bypass was the choice in five cases. An mRS of 0–2 was achieved in 77.3% of patients, typically <50 years old. Visual field appeared improved or unchanged in 36.3% and 63.6% of the symptomatic patients, respectively. In 76.1% of incidental aneurysms, campimetry was unaffected by surgery. A complete aneurysm exclusion was achieved in 93% of cases using a single procedure. No recurrences were documented on an average follow-up of 54.1 ± 34 months. Microneurosurgery is still a valuable, definitive, and durable option for Barami type Ia, Ib, or II paraclinoid aneurysm, especially in patients <50 years old and visually symptomatic. Conditions other than these are ideal candidates for FD stents.
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