Factors Determining Surgical Approaches to Basilar Bifurcation Aneurysms and Its Surgical Outcomes
ABSTRACT BACKGROUND: The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective. OB...
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Published in | Neurosurgery Vol. 78; no. 2; pp. 181 - 191 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Oxford University Press
01.02.2016
Copyright by the Congress of Neurological Surgeons Wolters Kluwer Health, Inc |
Subjects | |
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Abstract | ABSTRACT
BACKGROUND:
The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective.
OBJECTIVE:
To analyze the clinical and radiological factors that affect the selection of these classic surgical approaches and their outcomes.
METHODS:
A retrospective analysis was conducted on the clinical and radiological data from computed tomographic angiography of BBA that have been clipped in the Department of Neurosurgery of Helsinki University Central Hospital between 2004 and 2014. Statistical analyses were performed using parametric and nonparametric tests where values were considered significant below P = .05.
RESULTS:
One hundred four patients with BBA underwent surgical clipping in our department between 2004 and 2014. Eight patients were excluded from the study because of incomplete preoperative radiological evaluations, leaving 96 patients for further analysis. Multiple aneurysm clipping, mean basilar bifurcation angle, and aneurysm neck distance from posterior clinoid process were shown to be factors that determine the surgical approach. Unfavorable outcome is strongly associated with poor Hunt-Hess grade on admission, distance from aneurysm neck (the posterior clinoid process), thrombosis, and dome size.
CONCLUSION:
Microsurgery for BBA clipping can be performed safely with simple surgical approaches: subtemporal and LSO. There are several factors determining the approach selected. Poor patient outcome in BBA was highly associated with poor preoperative clinical grade and large size of aneurysm dome. |
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AbstractList | ABSTRACT
BACKGROUND:
The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective.
OBJECTIVE:
To analyze the clinical and radiological factors that affect the selection of these classic surgical approaches and their outcomes.
METHODS:
A retrospective analysis was conducted on the clinical and radiological data from computed tomographic angiography of BBA that have been clipped in the Department of Neurosurgery of Helsinki University Central Hospital between 2004 and 2014. Statistical analyses were performed using parametric and nonparametric tests where values were considered significant below P = .05.
RESULTS:
One hundred four patients with BBA underwent surgical clipping in our department between 2004 and 2014. Eight patients were excluded from the study because of incomplete preoperative radiological evaluations, leaving 96 patients for further analysis. Multiple aneurysm clipping, mean basilar bifurcation angle, and aneurysm neck distance from posterior clinoid process were shown to be factors that determine the surgical approach. Unfavorable outcome is strongly associated with poor Hunt-Hess grade on admission, distance from aneurysm neck (the posterior clinoid process), thrombosis, and dome size.
CONCLUSION:
Microsurgery for BBA clipping can be performed safely with simple surgical approaches: subtemporal and LSO. There are several factors determining the approach selected. Poor patient outcome in BBA was highly associated with poor preoperative clinical grade and large size of aneurysm dome. The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective. To analyze the clinical and radiological factors that affect the selection of these classic surgical approaches and their outcomes. A retrospective analysis was conducted on the clinical and radiological data from computed tomographic angiography of BBA that have been clipped in the Department of Neurosurgery of Helsinki University Central Hospital between 2004 and 2014. Statistical analyses were performed using parametric and nonparametric tests where values were considered significant below P = .05. One hundred four patients with BBA underwent surgical clipping in our department between 2004 and 2014. Eight patients were excluded from the study because of incomplete preoperative radiological evaluations, leaving 96 patients for further analysis. Multiple aneurysm clipping, mean basilar bifurcation angle, and aneurysm neck distance from posterior clinoid process were shown to be factors that determine the surgical approach. Unfavorable outcome is strongly associated with poor Hunt-Hess grade on admission, distance from aneurysm neck (the posterior clinoid process), thrombosis, and dome size. Microsurgery for BBA clipping can be performed safely with simple surgical approaches: subtemporal and LSO. There are several factors determining the approach selected. Poor patient outcome in BBA was highly associated with poor preoperative clinical grade and large size of aneurysm dome. BACKGROUND:The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective. OBJECTIVE:To analyze the clinical and radiological factors that affect the selection of these classic surgical approaches and their outcomes. METHODS:A retrospective analysis was conducted on the clinical and radiological data from computed tomographic angiography of BBA that have been clipped in the Department of Neurosurgery of Helsinki University Central Hospital between 2004 and 2014. Statistical analyses were performed using parametric and nonparametric tests where values were considered significant below P = .05. RESULTS:One hundred four patients with BBA underwent surgical clipping in our department between 2004 and 2014. Eight patients were excluded from the study because of incomplete preoperative radiological evaluations, leaving 96 patients for further analysis. Multiple aneurysm clipping, mean basilar bifurcation angle, and aneurysm neck distance from posterior clinoid process were shown to be factors that determine the surgical approach. Unfavorable outcome is strongly associated with poor Hunt-Hess grade on admission, distance from aneurysm neck (the posterior clinoid process), thrombosis, and dome size. CONCLUSION:Microsurgery for BBA clipping can be performed safely with simple surgical approachessubtemporal and LSO. There are several factors determining the approach selected. Poor patient outcome in BBA was highly associated with poor preoperative clinical grade and large size of aneurysm dome. ABBREVIATIONS:BBA, Basilar bifurcation aneurysmsBRAT, Barrow Rupture Aneurysm TrialCTA, computed tomography angiographyGOS, Glasgow Outcome scaleHH, Hunt-Hess scaleISAT, International Subarachnoid Aneurysm TrialISUIA, International Study of Unruptured Intracranial AneurysmsLSO, lateral supraorbitalPCP, posterior clinoid process BACKGROUND: The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective. OBJECTIVE: To analyze the clinical and radiological factors that affect the selection of these classic surgical approaches and their outcomes. METHODS: A retrospective analysis was conducted on the clinical and radiological data from computed tomographic angiography of BBA that have been clipped in the Department of Neurosurgery of Helsinki University Central Hospital between 2004 and 2014. Statistical analyses were performed using parametric and nonparametric tests where values were considered significant below P = .05. RESULTS: One hundred four patients with BBA underwent surgical clipping in our department between 2004 and 2014. Eight patients were excluded from the study because of incomplete preoperative radiological evaluations, leaving 96 patients for further analysis. Multiple aneurysm clipping, mean basilar bifurcation angle, and aneurysm neck distance from posterior clinoid process were shown to be factors that determine the surgical approach. Unfavorable outcome is strongly associated with poor Hunt-Hess grade on admission, distance from aneurysm neck (the posterior clinoid process), thrombosis, and dome size. CONCLUSION: Microsurgery for BBA clipping can be performed safely with simple surgical approaches: subtemporal and LSO. There are several factors determining the approach selected. Poor patient outcome in BBA was highly associated with poor preoperative clinical grade and large size of aneurysm dome. BACKGROUNDThe basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective.OBJECTIVETo analyze the clinical and radiological factors that affect the selection of these classic surgical approaches and their outcomes.METHODSA retrospective analysis was conducted on the clinical and radiological data from computed tomographic angiography of BBA that have been clipped in the Department of Neurosurgery of Helsinki University Central Hospital between 2004 and 2014. Statistical analyses were performed using parametric and nonparametric tests where values were considered significant below P = .05.RESULTSOne hundred four patients with BBA underwent surgical clipping in our department between 2004 and 2014. Eight patients were excluded from the study because of incomplete preoperative radiological evaluations, leaving 96 patients for further analysis. Multiple aneurysm clipping, mean basilar bifurcation angle, and aneurysm neck distance from posterior clinoid process were shown to be factors that determine the surgical approach. Unfavorable outcome is strongly associated with poor Hunt-Hess grade on admission, distance from aneurysm neck (the posterior clinoid process), thrombosis, and dome size.CONCLUSIONMicrosurgery for BBA clipping can be performed safely with simple surgical approaches: subtemporal and LSO. There are several factors determining the approach selected. Poor patient outcome in BBA was highly associated with poor preoperative clinical grade and large size of aneurysm dome. |
Author | Niemelä, Mika Tjahjadi, Mardjono Kivelev, Juri Kerro, Oleg Serrone, Joseph C. Maekawa, Hidetsugu Jahromi, Behnam Rezai Hernesniemi, Juha A. Lehto, Hanna |
AuthorAffiliation | Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland |
AuthorAffiliation_xml | – name: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland |
Author_xml | – sequence: 1 givenname: Mardjono surname: Tjahjadi fullname: Tjahjadi, Mardjono email: mardjonotjahjadi@gmail.com organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 2 givenname: Juri surname: Kivelev fullname: Kivelev, Juri organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 3 givenname: Joseph C. surname: Serrone fullname: Serrone, Joseph C. organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 4 givenname: Hidetsugu surname: Maekawa fullname: Maekawa, Hidetsugu organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 5 givenname: Oleg surname: Kerro fullname: Kerro, Oleg organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 6 givenname: Behnam Rezai surname: Jahromi fullname: Jahromi, Behnam Rezai organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 7 givenname: Hanna surname: Lehto fullname: Lehto, Hanna organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 8 givenname: Mika surname: Niemelä fullname: Niemelä, Mika organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland – sequence: 9 givenname: Juha A. surname: Hernesniemi fullname: Hernesniemi, Juha A. organization: 1Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26361096$$D View this record in MEDLINE/PubMed |
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BACKGROUND:
The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular... BACKGROUND:The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic... The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical... BACKGROUND: The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic... BACKGROUNDThe basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic... |
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SubjectTerms | Adult Aged Aneurysms Female Humans Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - surgery Male Microsurgery - methods Middle Aged Neurosurgery Neurosurgical Procedures - methods Radiography Retrospective Studies Surgical Instruments Treatment Outcome |
Title | Factors Determining Surgical Approaches to Basilar Bifurcation Aneurysms and Its Surgical Outcomes |
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