Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Mooren Str. 5, 40225, Düsseldorf, Germany.
Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan.
Acta Neurochir (Wien). 2024 Jan 30;166(1):50. doi: 10.1007/s00701-024-05942-1.
Posterior cerebral artery (PCA) aneurysms, though rare, pose treatment challenges. Endovascular therapy is the preferred option, but microsurgery becomes necessary in certain cases. Various microsurgical approaches have been suggested for PCA aneurysms, particularly those at the P2-P3 junction. This study highlights the trans-lateral ventricular approach (TVA) for addressing these complex aneurysms. This study aims to assess the feasibility and safety of the trans-lateral ventricular approach (TVA) for treating high-located complex PCA aneurysms at the P2-P3 junction. The study evaluates both clinical outcomes and anatomical considerations.
Two cases of PCA aneurysms at the P2-P3 junction were treated using TVA in 2019. Navigation-guided entry via the interparietal sulcus was planned. Ventriculostomy was performed from the cortex to the lateral ventricle's atrium. Medial atrial floor dissection exposed PCA's P2-P3 segments. Neuronavigation and ultrasound-aided guidance was used. Anatomical studies on fixed and contrast-perfused specimens refined the approach.
Both cases saw successful aneurysm clipping. The unruptured aneurysm patient was discharged in 6 days. The poor-grade SAH patient required extended ICU care, moving to rehabilitation with mRS = 4. The unruptured complex aneurysm case exhibited no deficits, returning to work in 3 months. Anatomical dissections validated TVA for high-located P2-P3 junction PCA aneurysms.
While endovascular therapy remains primary, this study demonstrates the viability of navigation-guided TVA for select high-located P2-P3 junction PCA aneurysms. Successes and challenges underscore the importance of patient selection and anatomical awareness.
尽管后交通动脉（PCA）动脉瘤较为罕见，但治疗颇具挑战性。血管内治疗是首选方法，但在某些情况下需要进行显微手术。针对 PCA 动脉瘤，特别是 P2-P3 交界处的动脉瘤，已经提出了各种显微手术入路。本研究强调了经外侧脑室入路（TVA）治疗这些复杂动脉瘤的可行性和安全性。本研究旨在评估经外侧脑室入路（TVA）治疗位于 P2-P3 交界处的高位复杂 PCA 动脉瘤的可行性和安全性。研究评估了临床结果和解剖学考虑因素。
2019 年，采用 TVA 治疗了 2 例位于 P2-P3 交界处的 PCA 动脉瘤。计划通过顶间沟进行导航引导入路。从皮质到侧脑室心房进行脑室造口术。内侧心房地板解剖暴露 PCA 的 P2-P3 段。使用神经导航和超声辅助引导。对固定和对比灌注标本进行解剖学研究，进一步优化了该入路。
2 例患者均成功夹闭了动脉瘤。未破裂的动脉瘤患者在 6 天后出院。而 SAH 分级较差的患者需要在 ICU 延长治疗，转至康复治疗，mRS 评分为 4 分。未破裂的复杂动脉瘤患者无神经功能缺损，在 3 个月后恢复工作。解剖学解剖验证了 TVA 治疗位于高位 P2-P3 交界处的 PCA 动脉瘤的可行性。
虽然血管内治疗仍是首选，但本研究表明，导航引导的 TVA 对于选择的高位 P2-P3 交界处 PCA 动脉瘤是可行的。成功和挑战突显了患者选择和解剖学意识的重要性。
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