Direct clipping of basilar trunk aneurysms using temporary balloon occlusion

Restricted access

✓ 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 The balloon was inflated tentatively to evaluate the appropriate inflation volume, then the balloon catheter was withdrawn back into the angiography catheter to prevent thrombus formation.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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1.

    Bailes JEDeeb ZWilson JAet al: Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping: technical note. Neurosurgery 31:6031992 (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 JEDeeb ZLWilson JAet al: Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping: technical note. Neurosurgery 30:9499531992Bailes 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 DLBoyer KLJoseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:1531591992Barrow 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 HHFrankfurt AIPurdy PDet al: Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 68:2342401988Batjer 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 26:961441979Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96–144 1979

    • Search Google Scholar
    • Export Citation
  • 6.

    Drake CGPeerless SJ: Posterior circulation aneurysms in Kikuchi HFukushima TWatanabe K (eds): Intracranial Aneurysms. Surgical Timing and Techniques. Niigata: Nishimura1986 pp 336348Drake 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 KTCahan LDHieshima GB: Intraoperative angiography using a portable digital subtraction unit. Technical note. J Neurosurg 64:8168181986Foley 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 WAKaplan BLDay ALet al: Evoked potential monitoring during aneurysm operation: observations after fifty cases. Neurosurgery 20:6786871987Friedman 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 SLMaceri DR: Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms. Technical note. J Neurosurg 69:4614661988Giannotta 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 GBReicher MAHigashida RTet al: Intraoperative digital subtraction neuroangiography: a diagnostic and therapeutic tool. AJNR 8:7597671987Hieshima 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 WEKosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79891974Hunt WE Kosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89 1974

    • Search Google Scholar
    • Export Citation
  • 12.

    Jennett BBond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:4804841975Jennett 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 DLStein BM: Combined supratentorial and infratentorial exposure for low-lying basilar aneurysms. Neurosurgery 4:4224261979Kasdon 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 TToya SShiobara Ret al: Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63:8578611985Kawase 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 AMKeane JFManninen PH: Monitoring of brainstem auditory evoked potentials during basilar artery occlusion in man. Br J Anaesth 57:9249281985Lam 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 JRLesser RPLuders H: Electrophysiological monitoring during basilar aneurysm operation. Neurosurgery 20:4214271987Little JR Lesser RP Luders H: Electrophysiological monitoring during basilar aneurysm operation. Neurosurgery 20:421–427 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Little JRLesser RPLueders Het al: Brain stem auditory evoked potentials in posterior circulation surgery. Neurosurgery 12:4965021983Little 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 NABentson JViñuela Fet al: Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 73:5265331990Martin 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 KTakahashi AYoshimoto T: Intraoperative endovascular techniques in the management of intracranial aneurysms in Schmedek HHSweet WH (eds:) Operative Neurosurgical Techniques: Indications Methods and Resultsed 3. Philadelphia: WB Saunders1994 (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 YYamane YTakahashi Met al: Prevention of thrombosis-related complications in cardiac catheterization and angiography using a heparinized catheter (Anthron). ASAIO Trans 33:3593651987Noishiki 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 WAKwan ESHeilman 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 27:1161191990Shucart 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 RAStein BM: Surgical approaches to aneurysms of the vertebral and basilar arteries. Neurosurgery 23:2032081988Solomon 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 RFDaspit CPPappas CTE: The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases. J Neurosurg 76:5885991992Spetzler 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 KKobayashi STakemae Tet al: Aneurysms of the basilar artery trunk. J Neurosurg 66:5005051987Sugita 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 JAbiko HMizoi Ket al: Protective effect of phenytoin and its enhanced action by combined administration with mannitol and vitamin E in cerebral ischaemia. Acta Neurochir 88:56641987Suzuki 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 JFujimoto SMizoi Ket al: The protective effect of combined administration of anti-oxidants and perfluo-rochemicals on cerebral ischemia. Stroke 15:6726791984Suzuki 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 JMizoi KYoshimoto T: Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg 64:1831901986Suzuki 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 JTakahashi AYoshimoto Tet al: Use of balloon occlusion and substances to protect ischemic brain during resection of posterior fossa AVM. Case report. J Neurosurg 63:6266291985Suzuki 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 JYoshomoto TKayama T: Surgical treatment of middle cerebral artery aneurysms. J Neurosurg 61:17231984Suzuki J Yoshomoto T Kayama T: Surgical treatment of middle cerebral artery aneurysms. J Neurosurg 61:17–23 1984

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 154 152 63
Full Text Views 148 98 0
PDF Downloads 69 29 0
EPUB Downloads 0 0 0
PubMed
Google Scholar