Multi-staged "hybrid" (open and endovascular) surgical treatment of VA thrombosed giant aneurysm by trapping and thrombectomy.

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Multi-staged "hybrid" (open and endovascular) surgical treatment of VA thrombosed giant aneurysm by trapping and thrombectomy.

World Neurosurg. 2018 Mar 15;:

Authors: Suzuki T, Kaku S, Nishimura K, Teshigawara A, Sasaki Y, Aoki K, Tanaka T, Karagiozov K, Murayama Y

Abstract
BACKGROUND: Surgical treatment of VA thrombosed giant aneurysms requires to achieve both obliteration of the parent artery to prevent bleeding and dome thrombectomy to relieve the brain stem from mass effect. To secure both proximal and distal control of complex VA aneurysms, contralateral approach to the aneurysm might be a useful alternative as previously described. We successfully treated a case of VA thrombosed giant aneurysm in a new original way by combining craniotomy (ipsilateral and contralateral) and endovascular technique.
CLINICAL PRESENTATION: A 48 year-old man presented with a thrombosed giant aneurysm of the right vertebral artery (VA) compressing the brain stem. The treatment consisted of endovascular proximal ligation of the VA followed by with two-staged craniotomy for complete trapping of the aneurysm and intra-aneurysmal thrombectomy. The VA distal to the aneurysm was obliterated via contralateral craniotomy as that only provided adequate working space. Finally, intra-aneurysmal partial thrombectomy was performed through an ipsilateral craniotomy, which also made possible the obliteration of the eventually dangerous remaining vasa vasorum and additional proximal ligation of the VA.
CONCLUSIONS: Based on pathological and surgical anatomical characteristics, a combination of an endovascular procedure with two-staged craniotomy for complete trapping, thrombectomy and vasa vasorum obliteration could be considered a feasible way to treat VA thrombosed giant aneurysms located ventral to the brain stem and have their distal neck portions/patent vessel beyond the midline towards the contralateral side.

PMID: 29551721 [PubMed - as supplied by publisher]

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