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| Name | Management of a Recurrent Coiled Giant Posterior Cerebral Artery Aneurysm: 3-D Video |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 04-09-2012 17:42:13 |
| Video Discription | Giant intracranial aneurysms are among the most difficult cerebrovascular lesions to treat, particularly when located at the basilar artery apex where thalamoperforators can be poorly visualized or adherent to the aneurysm. Dolichoectatic morphology, aberrant branch anatomy, wide aneurysm necks, intraluminal thrombus, and adherent perforating arteries prevent direct clipping in half of cases and require the use of alternative techniques like trapping to occlude the aneurysm. Intraluminal coils from previous endovascular treatment can also prevent direct clipping. Most of the time, trapping requires bypass to revascularize the occluded territory, but in some cases, natural collaterals can revascularize these territories. In this 3-D video, we present such a case of a 53 year-old female who presented with subarachnoid hemorrhage from a P1 segment posterior cerebral artery (PCA) aneurysm, was coiled at an outside institution, and made an excellent recovery. Over the following two years, she developed right sided hemiparesis due to progressive enlargement of the giant thrombotic aneurysm. An orbitozygomatic approach and a wide split of the sylvian fissure exposed the basilar bifurcation. The aneurysm respected the junction of the P2 PCA and the posterior communicating artery, which allowed trapping of the aneurysm without needing a bypass. However, the aneurysm and coil mass caused the clip blades to occlude perforators on the inflow and kink the P2 segment on the outflow. Extensive thrombectomy with an ultrasonic aspirator softened the base of the aneurysm, enabled clip readjustments, and decompressed the brain stem. A postoperative angiogram confirmed complete occlusion of the aneurysm and patency of perforator and branch arteries. The patient made an excellent recovery and was neurologically intact six months after surgery. |
| Category | Science & Technology |
| Tags | coiling | giant aneurysm | posterior cerebral artery | thrombectomy | trapping |
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