De Vilalta À, López P, Sanmillán JL, De Miquel M, Barranco R, Gabarrós A. Endovascular assisted vertebrobasilar junction aneurysm clipping in a hybrid operation room. Case report.
BRAIN AND SPINE 2022;
2:100884. [PMID:
36248172 PMCID:
PMC9560476 DOI:
10.1016/j.bas.2022.100884]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 11/24/2022]
Abstract
Introduction
We present a case of a 60-year-old female that underwent surgery for clipping a right vertebrobasilar junction aneurysm (VBJA) in a hybrid operation room.
Research question
Does the retrograde suction technique with a proximal balloon is safe and effective as an adjuvant technique in surgery of VBJA?
Material and methods
After an extended retrosigmoid approach was performed, a 6F Neuron catheter with an intermediate multipurpose catheter were navigated to the right vertebral artery (VA) through a 6-French sheath, which caused a severe catheter-induced vasospasm in the right VA. The aneurysm was then deflated and clipped. After the withdrawal of the catheter the vasospasm was resolved.
Results
The patient had a good recovery, with VI cranial nerve palsy and mild dysphagia due to mild right vocal cord palsy, both improving at 1-month follow-up and fully recovered at 6-month follow-up.
Discussion and conclusion
The combination of endovascular procedures and microsurgery at the same hybrid operation room in that case resulted in a safe and effective technique. It is an interesting tool that could help neurosurgeons deal with certain selected cases of VBJA. Intraoperative angiography offers the possibility to reposition a misplaced clip in the same surgery. Good collaboration between interventional neuroradiologists and vascular neurosurgeons helps in achieving good results in such difficult cases.
Endovascular assisted surgery could add safety and efficacy to the treatment of certain selected cases of VBJA.
Proximal balloon occlusion and retrograde suction minimize cranial nerve manipulation for achieving proximal control.
Collaboration between Interventional Neuroradiologists and Vascular Neurosurgeons is of utmost importance.
Intraoperative angiography offers the chance to reposition a misplaced clip in the same surgery.
A hybrid operation room is a useful tool for the treatment of some particular neurovascular malformations.
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