Microsurgical Clipping of Ruptured Posterior Fossa Aneurysms in the Semi-Sitting Position

Area of Science:

• Neurosurgery
• Vascular Neurology
• Surgical Oncology

Background:

• Posterior fossa aneurysms present significant surgical challenges due to deep location and proximity to critical neurovascular structures.
• The semi-sitting position, despite historical concerns regarding venous air embolism (VAE), may offer surgical advantages for these complex cases.

Purpose of the Study:

• To evaluate the safety and efficacy of microsurgical clipping for ruptured posterior fossa aneurysms using the semi-sitting position.

Main Methods:

• Retrospective review of 39 patients with ruptured posterior circulation aneurysms treated via microsurgical clipping in the semi-sitting position (1990-2023).
• Data collection included clinical presentation, surgical details, complications, and Glasgow Outcome Scale (GOS) at discharge and 6 months.

Main Results:

• Complete aneurysm occlusion was achieved in 92% of patients, with the posterior inferior cerebellar artery (PICA) being the most common location (79%).
• Intraoperative rupture occurred in 8%, and new neurological deficits in 13%. Venous air embolism (VAE) was detected in 20% of monitored patients but did not lead to procedure abortion or serious complications.
• Zero surgical mortality was observed, and 84% of surviving patients achieved a favorable outcome (GOS >3) at 6 months.

Conclusions:

• Microsurgical clipping of ruptured posterior fossa aneurysms in the semi-sitting position is a safe and effective treatment modality.
• Close collaboration with anesthesiology and appropriate monitoring are crucial for patient safety.
• The semi-sitting position remains a relevant and valuable surgical option for posterior fossa aneurysm treatment.