Subtemporal approach to posterior cerebral artery aneurysms

Area of Science:

• Neurosurgery
• Vascular Neurology
• Cerebrovascular Surgery

Background:

• Posterior cerebral artery (PCA) aneurysms are rare, leading to limited surgical experience.
• Microsurgical management of PCA aneurysms presents unique challenges due to their location and rarity.

Purpose of the Study:

• To describe the experience and outcomes of using the subtemporal approach for PCA aneurysms.
• To evaluate the safety and efficacy of the subtemporal approach in managing PCA aneurysms.

Main Methods:

• Retrospective review of 34 patients with 37 PCA aneurysms treated between 1980 and 2012.
• All patients underwent microsurgical management via the subtemporal approach at two Finnish neurosurgical centers.
• Procedures included neck clipping, proximal occlusion, trapping, wrapping, and bypass/revascularization techniques.

Main Results:

• Good outcomes (modified Rankin Scale 0-2) were achieved in 11 of 16 patients with ruptured aneurysms.
• 14 of 18 patients with incidentally diagnosed unruptured aneurysms had a good outcome.
• The most frequent serious complication was ipsilateral PCA infarction (35%), often associated with proximal occlusion or trapping.

Conclusions:

• The subtemporal approach is suitable for PCA aneurysms located in segments P1, P1-P2 junction, P2, and anterior P3.
• Proper cerebrospinal fluid release before temporal lobe retraction is crucial to prevent injury.
• The subtemporal approach provides adequate space for complex procedures like revascularization; complications stemmed from aneurysm nature, not the approach.