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4 results

  • Chapter 21 - Combined Transsylvian-Subtemporal Approach to Anterior Circulation and Basilar Apex Aneurysms

  • from Section II - Open Combined Approaches
  • Edited by Vijay Agarwal
  • Book:
    Integrated Management of Complex Intracranial Lesions
    Published online:
    05 October 2021
    Print publication:
    21 October 2021, pp 214-222

  • Summary

    Traditionally, two approaches have been utilized to access the rostral basilar artery (BA) for clipping aneurysms. These are: 1) the subtemporal approach pioneered by Canadian neurosurgeon Charles George Drake and 2) the transsylvian or pterional approach popularized by Turkish neurosurgeon Mahmut Gazi Yasargil. Both of these approaches have assets and liabilities, and both have modifications to expand the surgical field of view. Some rostral BA aneurysms and some patients with aneurysms of both the anterior and posterior circulation requiring clip ligation may benefit from a combined transsylvian and subtemporal (half-and-half) exposure. In this chapter, we describe our version of that approach, which provides access to both anterior and posterior circulation aneurysms. We detail neuroanesthesia considerations, patient positioning, bone drilling, subarachnoid dissection, and clip placement. Also included is an illustrative case.

  • Clipping of sigmoid sinus diverticulum: how I do it

  • F Hassannia, S D Carr, G-M Busato, J A Rutka
  • Journal:
    The Journal of Laryngology & Otology / Volume 132 / Issue 9 / September 2018
    Published online by Cambridge University Press:
    06 August 2018, pp. 837-839
    Print publication:
    September 2018
  • Objective

    To report two cases of transmastoid clipping of a sigmoid sinus diverticulum.

    Methods

    Two patients with pulsatile tinnitus resulting from a sigmoid sinus diverticulum underwent clipping at the diverticulum neck using intra-operative Doppler ultrasonography.

    Results

    At six months’ follow up, both patients reported complete resolution of pulsatile tinnitus with no complications.

    Conclusion

    Transmastoid clipping of a sigmoid sinus diverticulum can be a safe and effective method of managing pulsatile tinnitus resulting from a sigmoid sinus diverticulum.

  • Aneurysm Tears Caused by an Aneurysm Clip Springing from the Clip Applier

  • Yasuo Murai, Kazutaka Shirokane, Takao Kitamura, Fumihiro Matano, Akio Morita
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 44 / Issue 3 / May 2017
    Published online by Cambridge University Press:
    02 February 2017, pp. 326-328
    • Article
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  • We experienced two cases in which aneurysm clips sprang from the applier. In case 1, a subdural haematoma from a ruptured anterior cerebral artery aneurysm was detected. When the clip was opened for final positioning, it suddenly sprang from the applier and ruptured the aneurysm. In case 2, the clip suddenly sprang from the applier as the surgeon opened the applier to clip an unruptured anterior cerebral aneurysm. These accidental phenomena are rare but dangerous. We present these cases to help prevent similar occurrences in the future. Video recordings of actual procedures can point to potential mechanisms and help reduce the incidence of this complication.