Clinical observation of surgical treatment of posterior cerebral artery aneurysm

Abstract

Introduction. Surgical treatment of brain ruptured arterial aneurysms (AA) has no alternative and includes both microsurgical and endovascular interventions. In some cases AA microsurgical clipping is the only possible and adequate method of treatment.The most dangerous and difficult AA are aneurysms of cerebral arterial posterior semi-ring, in particular, located on basilar artery (BA) bifurcation and R1 segment of posterior cerebral artery (PCA).Material and methods. The result of surgical treatment of AA of left PCA initial part is given. Transcranial clipping of AA neck was performed under dynamic ultrasonic Doppler examination (UDE) control using flexible intraoperative sensor of catheter-type with frequency 16 MHz. Microsurgical access to BA bifurcation, R1 segment of PCA was used, aneurysmal neck blockage was made through left carotid-oculomotor triangle under UDE control from optic-carotid triangle. The operation was planned on the base of neurovisualizing methods results complex assessment (MRI, CT, cerebral angiography, UDE) with appropriate control after operation.Results and their discussion. Surgical treatment was performed routinely, the patient’s general state was satisfactory. The combined microsurgical access to initial PCA segment was used. Intraoperative UDE ensured the possibility to estimate hemodynamic situation in vessels of the appropriate zone after surgical intervention, and to control the extent of radicalism of operation.Conclusion. Technical possibilities of PCA AA microsurgical direct exclusion are the basis of differentiated application of intracranial methods at unproved advantages or technical difficulties of endovascular method under condition of surgical tactics planning and corresponding technical providing.