Surgical Strategies for Ruptured Complex Aneurysms Using Skull Base Technique and Revascularization Surgeries

Area of Science:

• Neurosurgery
• Vascular Neurology
• Surgical Oncology

Background:

• Complex aneurysms, including paraclinoid, thrombosed large, and vertebral-basilar dissecting types, present significant surgical challenges with high morbidity.
• Traditional surgical clipping can be difficult for these deep-seated lesions.

Purpose of the Study:

• To describe the experience and evaluate the effectiveness of skull base and bypass techniques for complex aneurysms.
• To discuss the advantages and potential pitfalls of these advanced surgical approaches.

Main Methods:

• Retrospective review of 22 consecutive patients with complex aneurysms treated between March 2012 and April 2017.
• Application of various skull base approaches and bypass techniques tailored to specific aneurysm locations and types.

Main Results:

• Diverse skull base approaches were utilized for paraclinoid, internal carotid artery (ICA), and vertebral dissecting aneurysms.
• Bypass procedures included occipital artery-posterior inferior cerebellar artery (OA-PICA) and superficial temporal artery-superior cerebellar artery.
• Overall favorable outcome was 63.6%, with no reported complications of re-rupture or incomplete clipping.

Conclusions:

• Skull base techniques provide a wide, shallow operative field, improving surgical outcomes for deeply located complex aneurysms.
• These techniques help minimize the risk of intraoperative neurovascular injury.