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Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping:
J E Bailes1, Z L Deeb, J A Wilson
1Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Insights
This study introduces a novel endovascular technique using a nondetachable balloon for proximal control of basilar artery aneurysms, improving surgical outcomes and enabling intraoperative angiography.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Direct surgical treatment of intracranial aneurysms, particularly in the posterior circulation, is often challenging due to complex anatomy and proximity to critical structures.
- Achieving proximal vascular control in these cases can be difficult, increasing surgical risks.
Purpose of the Study:
- To evaluate the feasibility and efficacy of intraoperative transfemoral catheterization with a nondetachable endovascular balloon for proximal control of basilar artery aneurysms.
- To assess the safety and benefits of this technique in facilitating surgical management and intraoperative imaging.
Main Methods:
- Four patients with basilar artery aneurysms underwent transfemoral catheterization for placement of a nondetachable silicone balloon catheter into the rostral basilar artery.
- The balloon was used for proximal control to facilitate aneurysm clipping or manage intraoperative rupture.
- Intraoperative angiography was utilized for confirmation of aneurysm obliteration and vessel patency.
Main Results:
- Excellent flow control in the basilar artery was achieved, facilitating surgical manipulation.
- Temporary basilar occlusion aided in aneurysm collapse and clip placement in two patients.
- Intraoperative aneurysm rupture in one patient was successfully controlled by balloon occlusion.
- Complete aneurysm obliteration and vessel patency were confirmed in all four patients post-procedure.
Conclusions:
- Intraoperative endovascular balloon occlusion of the basilar artery provides effective proximal control for complex intracranial aneurysms.
- This technique simplifies surgical management, aids in managing complications like rupture, and facilitates intraoperative angiography.
Abstract:
The direct surgical treatment of intracranial aneurysms is not always possible, especially in posterior circulation aneurysms. This is usually because of their complex anatomy and location next to the skull base and brain stem, where proximal vascular control is usually not attainable. Four patients at our institution underwent intraoperative transfemoral catheterization of the basilar artery with a nondetectable endovascular balloon for proximal control of the basilar artery. The flow control in the basilar artery was excellent and facilitated the surgery. Before surgery, each patient underwent the placement of a 10-cm 8-French femoral introducer sheath and were taken to the operating room where they were placed in a supine position and a subtemporal or pterional craniotomy was performed. After the initial exposure and before aneurysm manipulation, a nondetachable silicone balloon catheter was passed through an introducer catheter and was placed into the rostral basilar artery, using flow direction, microguidewires, and angiographic "road-mapping" techniques. In two patients, temporary basilar occlusion was used to collapse the aneurysm and to facilitate clip placement. In the third patient, intraoperative aneurysm rupture occurred and was controlled by temporary basilar artery occlusion. Using intraoperative angiography, complete aneurysm obliteration and vessel patency was confirmed in all four patients. All patients made a complete recovery except for initial postoperative third nerve palsies in three patients. This technique achieves intraoperative control of the basilar artery proximal to an aneurysm by the use of a nondetachable occlusive balloon in the basilar artery. An added benefit is the ease with which intraoperative angiography can be obtained in this context.(ABSTRACT TRUNCATED AT 250 WORDS)