Trapping of Vertebral Aneurysms Using Mid-lateral Suboccipital Approach, with Emphasis on Securing the Distal End

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  • SUGIYAMA Tatsuya
    Department of Neurosurgery, Showa University School of Medicine
  • MIZUTANI Tohru
    Department of Neurosurgery, Showa University School of Medicine
  • SUMI Kenji
    Department of Neurosurgery, Showa University School of Medicine
  • MATSUMOTO Masaki
    Department of Neurosurgery, Showa University School of Medicine
  • YABUSAKI Hajime
    Department of Neurosurgery, Showa University School of Medicine
  • KUSYAMAE Mika
    Department of Neurosurgery, Showa University School of Medicine
  • IRIE Ryo
    Department of Neurosurgery, Showa University School of Medicine
  • KAWAUCHI Yuta
    Department of Neurosurgery, Showa University School of Medicine
  • SAKAMOTO Yu
    Department of Neurosurgery, Showa University School of Medicine
  • SHIMIZU Katsuyoshi
    Department of Neurosurgery, Showa University School of Medicine
  • KUBO Minako
    Department of Neurosurgery, Showa University School of Medicine
  • KATO Yu
    Department of Neurosurgery, Showa University School of Medicine
  • IIZUKA Kazuki
    Department of Neurosurgery, Showa University School of Medicine

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Other Title
  • Mid-lateral suboccipital approachによる椎骨動脈瘤トラッピング術─特にdistal endの攻略について─

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Description

The lateral suboccipital approach is a well-known method for trapping and clipping of a vertebral artery aneurysm (VA-AN). However, in this approach, the deeply situated cranial window and the lower cranial nerves (LCNs) crossing the operative field interfere with the procedure. Here, we describe our alternative mid-lateral suboccipital approach, with the surgical results in 16 recent patients.<br>Sixteen patients with VA-ANs were admitted to our institute from May 2012 to December 2013. Of these, 2 underwent endovascular treatment. The other 14, including 3 with large VA-ANs, underwent open surgery. These included 8 cases of unruptured and 6 of ruptured VA-ANs. The patients were placed in the prone position. J-shaped skin incisions were made and osteoplastic craniotomies were advanced to the condyle fossa, thus providing wide, superficial operative views.<br>Trapping was performed in 7 of 14 cases. Proximal clipping was performed in 3 cases and neck clipping in 3 cases.<br>In our method, the wide, superficial operative field enables the surgeon to apply clips to a high position VA-AN and distal VA from under the LCNs. The method also facilitates occipital artery (OA) avulsion for bypass surgery, if needed.<br>Thus, the mid-lateral suboccipital approach appears to be an effective alternative to the lateral suboccipital approach.

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