Abstract
In the surgical treatment of basilar trunk aneurysm, there is still considerable difficulty in gaining both proximal artery control and a sufficient operative field. To overcome these problems, we used a neuroendoscope in a case with this type of lesion. A 68-year-old woman was admitted at our hospital after an episode of severe headache. CT showed a subarachnoid hemorrhage predominantly located in the perimesencephalic cistern. Angiography revealed an aneurysm in the distal one-third of the basilar trunk. The lesion was reached via a right subtemporal transtentorial approach. When the tentorium was incised, the operative field was occupied by a dome of aneurysm of 1.2cm in diameter. An endoscope (Clarus Murphy Scope, 2125-157) allowed the visualization of the vertebral arteries proximally, and the superior cerebellar artery distally. Furthermore, after verifying that there were no perforators branching from the basilar trunk, we placed a clip. The patient had an uneventful clinical course except for a normal pressure hydrocephalus which required installation of a VP shunt. We would like to stress the efficacy of neuroendoscopy especially in such a case with this rare and deep seated lesion.
