Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms
Based on the relationship between the posterior clinoid process and the basilar artery (BA) apex it may be difficult to obtain proximal control of the BA using temporary clips. Endovascular BA temporary balloon occlusion (TBO) can reduce aneurysm sac pressure, facilitate dissection/clipping, and fin...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-05-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/10/6/334 |
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| author | Jenny C. Kienzler Michael Diepers Serge Marbacher Luca Remonda Javier Fandino |
| author_facet | Jenny C. Kienzler Michael Diepers Serge Marbacher Luca Remonda Javier Fandino |
| author_sort | Jenny C. Kienzler |
| collection | DOAJ |
| description | Based on the relationship between the posterior clinoid process and the basilar artery (BA) apex it may be difficult to obtain proximal control of the BA using temporary clips. Endovascular BA temporary balloon occlusion (TBO) can reduce aneurysm sac pressure, facilitate dissection/clipping, and finally lower the risk of intraoperative rupture. We present our experience with TBO during aneurysm clipping of posterior circulation aneurysms within the setting of a hybrid operating room (hOR). We report one case each of a basilar tip, posterior cerebral artery, and superior cerebellar artery aneurysm that underwent surgical occlusion under TBO within an hOR. Surgical exposure of the BA was achieved with a pterional approach and selective anterior and posterior clinoidectomy. Intraoperative digital subtraction angiography (iDSA) was performed prior, during, and after aneurysm occlusion. Two patients presented with subarachnoid hemorrhage and one patient presented with an unruptured aneurysm. The intraluminal balloon was inserted through the femoral artery and inflated in the BA after craniotomy to allow further dissection of the parent vessel and branches needed for the preparation of the aneurysm neck. No complications during balloon inflation and aneurysm dissection occurred. Intraoperative aneurysm rupture prior to clipping did not occur. The duration of TBO varied between 9 and 11 min. Small neck aneurysm remnants were present in two cases (BA and PCA). Two patients recovered well with a GOS 5 after surgery and one patient died due to complications unrelated to surgery. Intraoperative TBO within the hOR is a feasible and safe procedure with no additional morbidity when using a standardized protocol and setting. No relevant side effects or intraoperative complications were present in this series. In addition, iDSA in an hOR facilitates the evaluation of the surgical result and 3D reconstructions provide documentation of potential aneurysm remnants for future follow-up. |
| first_indexed | 2024-03-10T19:30:09Z |
| format | Article |
| id | doaj.art-f1a3090bfac34d7aad6208782533be76 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-10T19:30:09Z |
| publishDate | 2020-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-f1a3090bfac34d7aad6208782533be762023-11-20T02:15:32ZengMDPI AGBrain Sciences2076-34252020-05-0110633410.3390/brainsci10060334Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation AneurysmsJenny C. Kienzler0Michael Diepers1Serge Marbacher2Luca Remonda3Javier Fandino4Department of Neurosurgery, Kantonsspital Aarau, CH-5000 Aarau, SwitzerlandDivision of Neuroradiology, Department of Radiology, Kantonsspital Aarau, 5000 Aarau, SwitzerlandDepartment of Neurosurgery, Kantonsspital Aarau, CH-5000 Aarau, SwitzerlandDivision of Neuroradiology, Department of Radiology, Kantonsspital Aarau, 5000 Aarau, SwitzerlandDepartment of Neurosurgery, Kantonsspital Aarau, CH-5000 Aarau, SwitzerlandBased on the relationship between the posterior clinoid process and the basilar artery (BA) apex it may be difficult to obtain proximal control of the BA using temporary clips. Endovascular BA temporary balloon occlusion (TBO) can reduce aneurysm sac pressure, facilitate dissection/clipping, and finally lower the risk of intraoperative rupture. We present our experience with TBO during aneurysm clipping of posterior circulation aneurysms within the setting of a hybrid operating room (hOR). We report one case each of a basilar tip, posterior cerebral artery, and superior cerebellar artery aneurysm that underwent surgical occlusion under TBO within an hOR. Surgical exposure of the BA was achieved with a pterional approach and selective anterior and posterior clinoidectomy. Intraoperative digital subtraction angiography (iDSA) was performed prior, during, and after aneurysm occlusion. Two patients presented with subarachnoid hemorrhage and one patient presented with an unruptured aneurysm. The intraluminal balloon was inserted through the femoral artery and inflated in the BA after craniotomy to allow further dissection of the parent vessel and branches needed for the preparation of the aneurysm neck. No complications during balloon inflation and aneurysm dissection occurred. Intraoperative aneurysm rupture prior to clipping did not occur. The duration of TBO varied between 9 and 11 min. Small neck aneurysm remnants were present in two cases (BA and PCA). Two patients recovered well with a GOS 5 after surgery and one patient died due to complications unrelated to surgery. Intraoperative TBO within the hOR is a feasible and safe procedure with no additional morbidity when using a standardized protocol and setting. No relevant side effects or intraoperative complications were present in this series. In addition, iDSA in an hOR facilitates the evaluation of the surgical result and 3D reconstructions provide documentation of potential aneurysm remnants for future follow-up.https://www.mdpi.com/2076-3425/10/6/334aneurysm clippingposterior circulation aneurysmtemporary balloon occlusionintraoperative digital subtraction angiographyhybrid operating room |
| spellingShingle | Jenny C. Kienzler Michael Diepers Serge Marbacher Luca Remonda Javier Fandino Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms Brain Sciences aneurysm clipping posterior circulation aneurysm temporary balloon occlusion intraoperative digital subtraction angiography hybrid operating room |
| title | Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms |
| title_full | Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms |
| title_fullStr | Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms |
| title_full_unstemmed | Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms |
| title_short | Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms |
| title_sort | endovascular temporary balloon occlusion for microsurgical clipping of posterior circulation aneurysms |
| topic | aneurysm clipping posterior circulation aneurysm temporary balloon occlusion intraoperative digital subtraction angiography hybrid operating room |
| url | https://www.mdpi.com/2076-3425/10/6/334 |
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