Presigmoid Approach for an Aneurysm of the Fenestrated Basilar Artery

Abstract

We report 3 cases with a ruptured aneurysm on the fenestrated basilar artery in relation to surgical approach. There were 2 females and 1 male, who were 47, 53 and 57 years old, respectively. On admission, a CT scan showed thick subarachnoid hemorrhage in 2 cases and thin in 1, and each case was classified into Grade 1, Grade 2 and Grade 4 of Hunt and Kosnik. All cases had an aneurysm rising from the proximal portion of the ventral side of the fenestrated basilar artery on the angiogram, which ranged in size from 3 to 5mm. The aneurysm was clipped completely in the chronic stage through the presigmoid route using the combined supra- and infratentorial transpetrosal approach. In 2 patients, postoperative courses were uneventful apart from abducens palsy and incompletely diminished hearing on the operative side. In the remaining 1, anticoagulant therapy had been done carefully for 14 days with 1-week barbiturate coma because of brain swelling due possibly to sigmoid sinus occlusion. She was discharged with hearing impairment 2 months after the surgery.
In this study, we discuss the usefulness and limitation of presigmoid approach for aneurysms of the basilar artery trunk and emphasize the intensively careful management with barbiturate coma and/or anti-coagulant therapy after an unexpectedly invasive surgery.