Direct clipping of basilar trunk aneurysms using temporary balloon occlusion

View More View Less
  • 1 Division of Neurosurgery, Tohoku University School of Medicine; Department of Neurosurgery, Kohnan Hospital; and Department of Neurosurgery, Iwate Medical University, Sendai, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ In the surgical treatment of basilar trunk aneurysms, there is still considerable technical difficulty in gaining both proximal artery control and a sufficient operative field. The authors describe their experience in five patients with basilar trunk aneurysms treated using temporary balloon occlusion and intraoperative digital subtraction angiography. With the patient under general anesthesia, a heparinized angiography catheter was guided into the dominant vertebral artery by means of the Seldinger technique. A silicone balloon catheter was introduced coaxially through the angiography catheter to the basilar artery just proximal to the aneurysm. The balloon was inflated tentatively to evaluate the appropriate inflation volume, then the balloon catheter was withdrawn back into the angiography catheter to prevent thrombus formation. After exposure of the aneurysm, the occlusion balloon was advanced again and inflated temporarily within the basilar artery to prevent premature rupture and to facilitate dissection of the aneurysm. The mean duration of temporary balloon occlusion was 22 minutes. There were no patients with postoperative deficits attributable to the temporary occlusion. The results of aneurysm clip placement were confirmed by intraoperative digital subtraction angiography immediately after clipping. No patient suffered from distal embolism or other complications related to vessel catheterization. From this experience, it is concluded that this intraoperative endovascular technique can contribute to the success of surgery for complex cerebral aneurysms, particularly for basilar trunk aneurysms in which proximal vascular control is difficult.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Kazuo Mizoi, M.D., Department of Neurosurgery, Tohoku University School of Medicine, 1–1 Seiryo-cho, Aoba-Ku, Sendai 982, Japan.
  • 1.

    Bailes JE, , Deeb Z, & Wilson JA, et al: Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping: technical note. Neurosurgery 31:603, 1992 (Letter) Bailes JE, Deeb Z, Wilson JA, et al: Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping: technical note. Neurosurgery 31:603, 1992 (Letter)

    • Search Google Scholar
    • Export Citation
  • 2.

    Bailes JE, , Deeb ZL, & Wilson JA, et al: Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping: technical note. Neurosurgery 30:949953, 1992 Bailes JE, Deeb ZL, Wilson JA, et al: Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping: technical note. Neurosurgery 30:949–953, 1992

    • Search Google Scholar
    • Export Citation
  • 3.

    Barrow DL, , Boyer KL, & Joseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:153159, 1992 Barrow DL, Boyer KL, Joseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:153–159, 1992

    • Search Google Scholar
    • Export Citation
  • 4.

    Batjer HH, , Frankfurt AI, & Purdy PD, et al: Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 68:234240, 1988 Batjer HH, Frankfurt AI, Purdy PD, et al: Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 68:234–240, 1988

    • Search Google Scholar
    • Export Citation
  • 5.

    Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96144, 1979 Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96–144, 1979

    • Search Google Scholar
    • Export Citation
  • 6.

    Drake CG, & Peerless SJ: Posterior circulation aneurysms, in Kikuchi H, , Fukushima T, & Watanabe K (eds): Intracranial Aneurysms. Surgical Timing and Techniques. Niigata: Nishimura, 1986, pp 336348 Drake CG, Peerless SJ: Posterior circulation aneurysms, in Kikuchi H, Fukushima T, Watanabe K (eds): Intracranial Aneurysms. Surgical Timing and Techniques. Niigata: Nishimura, 1986, pp 336–348

    • Search Google Scholar
    • Export Citation
  • 7.

    Foley KT, , Cahan LD, & Hieshima GB: Intraoperative angiography using a portable digital subtraction unit. Technical note. J Neurosurg 64:816818, 1986 Foley KT, Cahan LD, Hieshima GB: Intraoperative angiography using a portable digital subtraction unit. Technical note. J Neurosurg 64:816–818, 1986

    • Search Google Scholar
    • Export Citation
  • 8.

    Friedman WA, , Kaplan BL, & Day AL, et al: Evoked potential monitoring during aneurysm operation: observations after fifty cases. Neurosurgery 20:678687, 1987 Friedman WA, Kaplan BL, Day AL, et al: Evoked potential monitoring during aneurysm operation: observations after fifty cases. Neurosurgery 20:678–687, 1987

    • Search Google Scholar
    • Export Citation
  • 9.

    Giannotta SL, & Maceri DR: Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms. Technical note. J Neurosurg 69:461466, 1988 Giannotta SL, Maceri DR: Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms. Technical note. J Neurosurg 69:461–466, 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Hieshima GB, , Reicher MA, & Higashida RT, et al: Intraoperative digital subtraction neuroangiography: a diagnostic and therapeutic tool. AJNR 8:759767, 1987 Hieshima GB, Reicher MA, Higashida RT, et al: Intraoperative digital subtraction neuroangiography: a diagnostic and therapeutic tool. AJNR 8:759–767, 1987

    • Search Google Scholar
    • Export Citation
  • 11.

    Hunt WE, & Kosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:7989, 1974 Hunt WE, Kosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89, 1974

    • Search Google Scholar
    • Export Citation
  • 12.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 13.

    Kasdon DL, & Stein BM: Combined supratentorial and infratentorial exposure for low-lying basilar aneurysms. Neurosurgery 4:422426, 1979 Kasdon DL, Stein BM: Combined supratentorial and infratentorial exposure for low-lying basilar aneurysms. Neurosurgery 4:422–426, 1979

    • Search Google Scholar
    • Export Citation
  • 14.

    Kawase T, , Toya S, & Shiobara R, et al: Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63:857861, 1985 Kawase T, Toya S, Shiobara R, et al: Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63:857–861, 1985

    • Search Google Scholar
    • Export Citation
  • 15.

    Lam AM, , Keane JF, & Manninen PH: Monitoring of brainstem auditory evoked potentials during basilar artery occlusion in man. Br J Anaesth 57:924928, 1985 Lam AM, Keane JF, Manninen PH: Monitoring of brainstem auditory evoked potentials during basilar artery occlusion in man. Br J Anaesth 57:924–928, 1985

    • Search Google Scholar
    • Export Citation
  • 16.

    Little JR, , Lesser RP, & Luders H: Electrophysiological monitoring during basilar aneurysm operation. Neurosurgery 20:421427, 1987 Little JR, Lesser RP, Luders H: Electrophysiological monitoring during basilar aneurysm operation. Neurosurgery 20:421–427, 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Little JR, , Lesser RP, & Lueders H, et al: Brain stem auditory evoked potentials in posterior circulation surgery. Neurosurgery 12:496502, 1983 Little JR, Lesser RP, Lueders H, et al: Brain stem auditory evoked potentials in posterior circulation surgery. Neurosurgery 12:496–502, 1983

    • Search Google Scholar
    • Export Citation
  • 18.

    Martin NA, , Bentson J, & Viñuela F, et al: Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 73:526533, 1990 Martin NA, Bentson J, Viñuela F, et al: Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 73:526–533, 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Mizoi K, , Takahashi A, & Yoshimoto T: Intraoperative endovascular techniques in the management of intracranial aneurysms, in Schmedek HH, & Sweet WH (eds:) Operative Neurosurgical Techniques: Indications, Methods, and Results, ed 3. Philadelphia: WB Saunders, 1994 (In press) Mizoi K, Takahashi A, Yoshimoto T: Intraoperative endovascular techniques in the management of intracranial aneurysms, in Schmedek HH, Sweet WH (eds:) Operative Neurosurgical Techniques: Indications, Methods, and Results, ed 3. Philadelphia: WB Saunders, 1994 (In press)

    • Search Google Scholar
    • Export Citation
  • 20.

    Noishiki Y, , Yamane Y, & Takahashi M, et al: Prevention of thrombosis-related complications in cardiac catheterization and angiography using a heparinized catheter (Anthron). ASAIO Trans 33:359365, 1987 Noishiki Y, Yamane Y, Takahashi M, et al: Prevention of thrombosis-related complications in cardiac catheterization and angiography using a heparinized catheter (Anthron). ASAIO Trans 33:359–365, 1987

    • Search Google Scholar
    • Export Citation
  • 21.

    Shucart WA, , Kwan ES, & Heilman CB: Temporary balloon occlusion of a proximal vessel as an aid to clipping aneurysms of the basilar and paraclinoid internal carotid arteries: technical note. Neurosurgery 27:116119, 1990 Shucart WA, Kwan ES, Heilman CB: Temporary balloon occlusion of a proximal vessel as an aid to clipping aneurysms of the basilar and paraclinoid internal carotid arteries: technical note. Neurosurgery 27:116–119, 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Solomon RA, & Stein BM: Surgical approaches to aneurysms of the vertebral and basilar arteries. Neurosurgery 23:203208, 1988 Solomon RA, Stein BM: Surgical approaches to aneurysms of the vertebral and basilar arteries. Neurosurgery 23:203–208, 1988

    • Search Google Scholar
    • Export Citation
  • 23.

    Spetzler RF, , Daspit CP, & Pappas CTE: The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 76:588599, 1992 Spetzler RF, Daspit CP, Pappas CTE: The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 76: 588–599, 1992

    • Search Google Scholar
    • Export Citation
  • 24.

    Sugita K, , Kobayashi S, & Takemae T, et al: Aneurysms of the basilar artery trunk. J Neurosurg 66:500505, 1987 Sugita K, Kobayashi S, Takemae T, et al: Aneurysms of the basilar artery trunk. J Neurosurg 66:500–505, 1987

    • Search Google Scholar
    • Export Citation
  • 25.

    Suzuki J, , Abiko H, & Mizoi K, et al: Protective effect of phenytoin and its enhanced action by combined administration with mannitol and vitamin E in cerebral ischaemia. Acta Neurochir 88:5664, 1987 Suzuki J, Abiko H, Mizoi K, et al: Protective effect of phenytoin and its enhanced action by combined administration with mannitol and vitamin E in cerebral ischaemia. Acta Neurochir 88:56–64, 1987

    • Search Google Scholar
    • Export Citation
  • 26.

    Suzuki J, , Fujimoto S, & Mizoi K, et al: The protective effect of combined administration of anti-oxidants and perfluo-rochemicals on cerebral ischemia. Stroke 15:672679, 1984 Suzuki J, Fujimoto S, Mizoi K, et al: The protective effect of combined administration of anti-oxidants and perfluo-rochemicals on cerebral ischemia. Stroke 15:672–679, 1984

    • Search Google Scholar
    • Export Citation
  • 27.

    Suzuki J, , Mizoi K, & Yoshimoto T: Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg 64:183190, 1986 Suzuki J, Mizoi K, Yoshimoto T: Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg 64:183–190, 1986

    • Search Google Scholar
    • Export Citation
  • 28.

    Suzuki J, , Takahashi A, & Yoshimoto T, et al: Use of balloon occlusion and substances to protect ischemic brain during resection of posterior fossa AVM. Case report. J Neurosurg 63:626629, 1985 Suzuki J, Takahashi A, Yoshimoto T, et al: Use of balloon occlusion and substances to protect ischemic brain during resection of posterior fossa AVM. Case report. J Neurosurg 63:626–629, 1985

    • Search Google Scholar
    • Export Citation
  • 29.

    Suzuki J, , Yoshomoto T, & Kayama T: Surgical treatment of middle cerebral artery aneurysms. J Neurosurg 61:1723, 1984 Suzuki J, Yoshomoto T, Kayama T: Surgical treatment of middle cerebral artery aneurysms. J Neurosurg 61:17–23, 1984

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 255 98 7
Full Text Views 148 0 0
PDF Downloads 71 2 1
EPUB Downloads 0 0 0