Soni Tushar V, Patel Shreyansh, Shah Varshesh, Singh Sandip, Shah Nirav
Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.
Asian J Neurosurg. 2024 May 9;19(2):321-326. doi: 10.1055/s-0044-1786704. eCollection 2024 Jun.
The International Subarachnoid Aneurysm Trial led to a shift from clipping to endovascular coiling as the primary therapy for cerebral aneurysm particularly in the management of posterior circulation aneurysm. However, endovascular therapy is often unavailable in low-resource settings, emphasizing the importance of maintaining surgical skill sets in resource-poor countries. This article presents a detailed case report on the successful microneurosurgical management of a 65-year-old female with a history of headache and weakness with past history of hypertension and a right posterior cerebral artery territory infarct who was diagnosed with a ruptured aneurysm situated within the intracranial vertebral artery. Patient was operated with the far lateral approach and clipping of the aneurysm. This case report elucidates the intricate surgical techniques employed, and the challenges neurosurgeons encountered in treating posterior circulation intracranial aneurysms, particularly those with ruptured complications. The aneurysms' intricate anatomy and increased rupture risk necessitate a meticulous microneurosurgical approach. The severity of subarachnoid hemorrhage from ruptured aneurysms increases morbidity and mortality rates.
国际蛛网膜下腔动脉瘤试验导致了从夹闭术到血管内栓塞术的转变，血管内栓塞术成为脑动脉瘤的主要治疗方法，尤其是在后循环动脉瘤的治疗中。然而，在资源匮乏地区往往无法进行血管内治疗，这凸显了在资源匮乏国家保持手术技能的重要性。本文详细介绍了一例65岁女性患者的成功显微神经外科治疗病例，该患者有头痛和虚弱病史，既往有高血压和右侧大脑后动脉区域梗死病史，被诊断为颅内椎动脉破裂动脉瘤。患者采用远外侧入路进行动脉瘤夹闭手术。本病例报告阐明了所采用的复杂手术技术，以及神经外科医生在治疗后循环颅内动脉瘤，特别是那些伴有破裂并发症的动脉瘤时所遇到的挑战。动脉瘤复杂的解剖结构和增加的破裂风险需要细致的显微神经外科手术方法。破裂动脉瘤引起的蛛网膜下腔出血的严重程度会增加发病率和死亡率。
