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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(01): 27-37
DOI: 10.1055/s-0038-1639589
Miscellaneous | Artigo de Atualização
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

Tratamento cirúrgico de aneurismas de circulação posterior – estudo anatômico e técnica cirúrgica
Vitor Nagai Yamaki
1   Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
Eric Homero Albuquerque Paschoal
1   Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
2   Division of Neurosurgery, Universidade Federal do Pará, Belém, PA, Brazil
,
Manoel Jacobsen Teixeira
1   Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo
1   Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
› Institutsangaben Funding Information There was no funding supporting this research project.
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Publikationsverlauf

22. August 2017

05. Januar 2018

Publikationsdatum:
02. April 2018 (online)

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Abstract

Posterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

Resumo

Aneurismas de circulação posterior representam de 10–15% dos aneurismas intracranianos. O diagnóstico, frequentemente, é secundário a hemorragia subaracnoide devido à apresentação assintomática na maioria dos casos e ao alto risco de sangramento comparado com aneurismas da circulação anterior. O tratamento cirúrgico de aneurismas de circulação posterior é complexo e desafiador para os neurocirurgiões devido à anatomia particular da região, profundidade do acesso cirúrgico, e relação intima com o tronco encefálico e os nervos cranianos. Aneurismas de diferentes localizações têm diferentes relações anatômicas e, portanto, acessos cirúrgicos específicos para melhor dissecção e visibilização de estruturas. Logo, um conhecimento detalhado de anatomia é mandatório para planejamento operatório individualizado e bons resultados clinico-radiológicos. Foram selecionadas as principais localizações de aneurismas de circulação posterior: Artéria cerebelar póstero-inferior; tronco de artéria basilar, bifurcação de artéria basilar, artéria cerebral posterior, e artéria cerebelar superior para detalhamento anatômico da anatomia relevante. O estudo objetiva realizar uma revisão da literatura dos principais resultados sobre tratamento cirúrgico de aneurismas de circulação posterior, além de descrever os principais pontos anatômicos relevantes à técnica microcirúrgica.

Keywords

intracranial aneurysms - surgical treatment - microsurgery - brain anatomy

Palavras-Chave

aneurisma intracraniano - tratamento cirúrgico - microcirurgia - anatomia cerebral

Ethical Statement

We confirm that this study is original, never published, and it is not under consideration by any other journal. This research is in compliance with ethical standards and an informed consent was obtained from all individual participants included in the study. There was no funding supporting this research project. The authors declare that they have no conflicts of interest.


 

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