Color Atlas of Microneurosurgery: Microanatomy, Approaches and Techniques: 3

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Submission of a review does not automatically guarantee your review will be published. Delivery FAQS. Returns Policy. Spetzler Electronic book text 0 Review s. Reviews Terms and Conditions: Writing and submitting a Review: Your review must be in your own words, and no more than 60 words - be concise! You might also like The aneurysm is being resected, along with the involved artery. Figure a, re printe d with pe rmis s ion of J ourna l of Ne uros urge ry.

Re printe d with pe rmis s ion of J ourna l of Ne uros urge ry.

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The anteri or temporal bra nch, which arises proximal to the aneurysm, is visible in the Sylvian fissure. One month later right , a repeat angiogram de monstra te s dilation of the a nte rior te mpora l bra nch. Re printe d with pe rmis - s ion of J ourna l of Ne uros urge ry. The patient has had no further ischemic events during a 5-year follow-up. The proximal and distal middle cerebral artery orifices are visible. Therefore, the distal portion of the middle cerebral artery was reconstructed with suture 10—0 , and the remainder of the aneurysm neck was occlude d proximally and dis - tally.

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A superficial tempora l a rtery-to-distal middle cerebral artery bypass was used to perfuse the dis tal middle cerebral artery. Ane urysms—Ante rior Circula tion The remaining middle ce re bral artery branches fill through the superficial temporal artery bypass. This probable dis secting aneurysm had been followe d for 7 years with recent growth over a 6-month pe riod. The patient's symptoms included fluc tuating periodic aphasia. Ane urysms —Ante rior Circula tion Coils were placed aneurysm. The patient had no neurologic into the vessel until it was obs tructe d com deficit.

Re printe d with pe rmis s ion of J our- na l of Ne uros urge ry. The other branch of the superficial tempora l artery is being prepared for the se cond anastomosis. The two aneurysm clips occlude the cut ends of the middle cerebral artery branches as they exit the aneurysm. The s e rpe n tine portion no longer fills.

The two aneurysm clips placed during the first stage were removed and the anastomosis a rrow is s hown. The previously performed bypass is vis i-.

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Re printe d with pe rmis s ion of J ourna l of Ne uro- s urge ry. This patient had no postoperative neurological deficit and has been free of headaches for 4 years. Ane urys ms—Ante rior Circula tion The drawing illustrates the positior of an occlusive detachable balloon jus t before entering the aneurysm. This M1 occlusion was done after a left extracranial-intracranial bypass operation performed 1 week previ ously. The middle cerebral artery territory is supplied via the extracranial-intracranial bypass; the satellite aneurysm is filled via ret rograde flow.

The temporalis muscle is divided and elevated, leaving a cuff for later reattachment. Ane urys ms —P os te rior Circula tion The fat pa d, which prote cts the frontalis branch of the facial nerve, is preserved on the side of the scalp fla p. The orbital roof and zygoma are e xpose d. An oscillating saw is pre ferred.

Notice the additional exposure gained from the orbitozygomatic approach. Remember that the internal ca rotid artery may erode the base of the posterior clinoid when drilling. The superior cerebellar and both posterior cerebral arteries are visible. Great care must be ta ken so that no perforators from the P1 segments are caught within the clip. A se cond clip is visible on an incidental posterior communicating artery aneurysm. Case 3—49 Diagnosis: BA aneurysm rel. Case 3—50 Diagnosis: Giant BA aneurysm high riding rel.

The temporalis muscle has been ele va te d. This patient presented with progressive brainstem dys function. Before the imaging study, it wa s assumed that the arteriovenous malformation had hemor rhaged. The smaller posterior cerebral artery aneurysm has not grown. Both circulatory arrest, the perforators can be dis posterior cerebral arteries and the perforating sected safely from the dome of the branches are visible. S upe rior ce re be lla r a rte ry. The patient's arteriovenous malfor mation was resected at a later date.

Case 3—52 Diagnosis: Giant BA aneurysm rel.

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This approach remains an excellent choice for basilar artery aneurysms. However, the wide exposures obtained through the orbltozygoma tic a pproa ch—with its advantages of being able to clip associated aneurysms of the anterior circulation as well as minimizing trauma to the oculomotor nerve—make it the senior author's preferred exposure for basilar aneurysms.

Case 3—53 Diagnosis: Giant calcified and thrombosed BA aneurysm rel.

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The patient presented with progressive quadriparesis. The left supe ri or cerebellar artery arrow is draped around the mass of the aneurysm. The superior cerebellar artery and the posterior cerebral artery are emerging from the aneurysm. Case 3—54 Diagnosis: BA aneurysm, regrowth after endovascular treatment rel.

One coil has migrated through the wall of the aneurysm.

Color Atlas of Microneurosurgery: Microanatomy, Approaches and Techniques: 3

Case 3—55 Diagnosis: Basilar tip aneurysm rel. This year-old female who presented with a subarachnoid hemor rhage, was a poor operative risk a nd the re fore was selected for treatment with GDC coils. Exposure of the vertebral artery in the neck allowed insertion of the catheter, which was the n navigated to the base of the aneurysm.

The aneurysm was coiled to the point of obliterating the dome. Case 3—56 Diagnosis: Basilar tip aneurysm rel. This obese patient was considered a poor surgical risk and therefore was treate d with GDC coils. Note tha t the aneurysm is bilobu- lated with the posterior cerebral artery form ing part of the comple x. A balloon placed into the posterior cerebral artery at this point obliterated the artery and the aneurysm. Ane urysms—Posterior Circula tion Also, note the marked diminution of the posterior cerebral artery.

The large ves sel on the right is the superior cerebellar artery. Case 3—59 Diagnosis: Left superior cerebellar artery aneurysm rel. The optic nerve is covered with a cot- seen. Case 3—60 Diagnosis: Right giant superior cerebellar artery aneurysm rel. This young patient presented with ischemic s ymptoms from the occlusion of the superior cerebellar artery and progressive mass effect. The patient made an excellent recovery and returned to her acting career. Case 3—61 Diagnosis: Peripheral superior cerebellar artery aneurysm rel.

The e ti ology of this aneurysm is uncertain. The patient presented with hemorrhage. Case 3—62 Diagnosis: Upper basilar trunk aneurysm projecting inferiorly and anteriorly rel. The retractor holds the oculomotor clippe d. Notice the aneurysm dome as it anteriorly from the basilar artery.

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A large por tion of the brainstem is e xpos e d. Here the approach varies in tha t the exposure is directed below the oculomotor nerve. Case 3—63 Diagnosis: Large BA trunk aneurysm arising from below the superior cerebellar artery rel. Case 3—64 Diagnosis: Upper basilar trunk aneurysm rel. The rate the fascia on the temporalis muscle on patient presented with subarachnoid hemor the fat pad to protect the frontalis branch of rhage as well as right hemiparesis, pre s um the facial nerve.

An appropriate hole is drilled on the other side of the saw cut so that nor mal anatomical alignment can be achieved during re construction. A cuff is left a tta ched to the bone of the temporal muscle to permit its reattachment at the end of the case. The temporalis muscle is reattached to its residual cuff on the craniotomy site, and the scalp is reapproximated. The patient recovered completely and delivered a healthy infant. Case 3—65 Diagnosis: Basilar trunk aneurysm rel.