Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
권호 표지

Surgical Treatment for Vertebral Artery and Posterior Inferior Cerebellar Artery Aneurysms Via Transcondylar Approach or Transcondylar Fossa Approach

경후두과 접근법 및 경후두과와 접근법을 이용한 추골동맥 및 후하소뇌동맥 동맥류의 수술적 치료

  • Yang, Na-Rae (Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital) ;
  • Seo, Eui Kyo (Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital)
  • 양나래 (이화여자대학교 목동병원, 신경외과) ;
  • 서의교 (이화여자대학교 목동병원, 신경외과)
  • Published : 2011.09.30
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Abstract

Objective : Since posterior circulation vascular lesions are adjacent to important structures such as the brain stem and lower cranial nerves, the acquisition of anatomical information and the careful selection of approaches are essential for the surgical treatment of these lesions. We examined the characteristics and the indications of the far lateral suboccipital approach which exposes lesions without retraction of the brain stem for the treatment of either a vertebral artery (VA) or posterior inferior cerebellar artery (PICA) aneurysm. We present the best diagnostic tool to determine the approaches. Methods : We have reviewed 11 patients who received surgical treatments between 2005 and 2011 for VA or PICA aneurysms. All of the patients had 3-dimensional computed tomography (3DCT) angiography performed to investigate the relation of the location between the aneurysm and hypoglossal canal. Results : Eight of the 11 patients were treated with the transcondylar fossa approach (TCFA) as their lesions were located proximal to the hypoglossal canal, while three were treated with the transcondylar approach (TCA) as their lesions were located distal to the hypoglossal canal. Of the three patients treated with the TCA, one had temporary palsy of the $11^{th}$ cranial nerve and the others recovered without any neurological defects. 3DCT angiography showed the relation of the location between the aneurysm and hypoglossal canal. Conclusion : The TCFA and TCA are good approaches to expose lesions without retraction of the brain stem. To determine the approaches for the surgery of VA or PICA aneurysms, using 3DCT before surgery is advantageous in understanding the positional relations between the hypoglossal canal and the lesions. During the actual surgery, the posterior condylar canal through which the posterior condylar emissary vein passes can be used as an anatomical landmark for TCFA. With this approach, craniocervical instability can be avoided.

Keywords

References

  1. Andoh T, Shirakami S, Nakashima T, Nishimura Y, Sakai N, Yamada H, et al. Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987-93, 1992 https://doi.org/10.1227/00006123-199212000-00001
  2. Bertalanffy H, Seeger W. The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction. Neurosurgery 29:815-21, 1991 https://doi.org/10.1227/00006123-199112000-00002
  3. Bertalanffy H, Sure U, Petermeyer M, Becker R, Gilsbach JM. Management of aneurysms of the vertebral artery-posterior inferior cerebellar artery complex. Neurol Med Chir 38:93-103, 1998 https://doi.org/10.2176/nmc.38.suppl_93
  4. de Oliveira E, Rhoton AL Jr, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 24:293-352, 1985 https://doi.org/10.1016/0090-3019(85)90042-4
  5. Gilsbach JM, Sure U, Mann W. The supracondylar approach to the jugular tubercle and hypoglossal canal. Surg Neurol 50:563-70, 1998 https://doi.org/10.1016/S0090-3019(97)00378-9
  6. Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 64:559-62, 1986 https://doi.org/10.3171/jns.1986.64.4.0559
  7. Horowitz M, Kopitnik T, Landreneau F, Krummerman J, Batjer HH, Thomas G, et al. Posteroinferior cerebellar artery aneurysm: surgical results for 38 patients. Neurosurgery 43:1026-32, 1998 https://doi.org/10.1097/00006123-199811000-00012
  8. Hung T. Wen, Alrbert L. Rhoton, Toshiro K, de Oliveira E. Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87:555-85, 1997 https://doi.org/10.3171/jns.1997.87.4.0555
  9. Karam YR, Menezes AH, Traynelis VC. Posterolateral approaches to the craniobvertebral junction. Neurosurgery 66:135-40, 2010 https://doi.org/10.1227/01.NEU.0000365828.03949.D0
  10. Krayenbuhil N, Guerrero CA, Krisht AF. Technical strategies to approach of the vertebral and posterior inferior cerebellar arteries. Neurosurg Fucus 19:1-5, 2005
  11. Lee KS, Gower DJ, Branch CL Jr, Kelly DL Jr, McWhorter JM, Bell WO. Surgical repair of aneurysms of the posterior inferior cerebellar artery-a clinical series. Surg Neurol 31:85-91, 1989 https://doi.org/10.1016/0090-3019(89)90316-9
  12. Matsushima T, Matsukado L, Natori Y, Inamura T, Hitotsumatsu T, Fukui M. Surgery on a saccular vertebral artery-posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach of the transcondylar approach: surgical results and indications for using two different lateral skull base approaches. J Neurosurg 95:268-74, 2001 https://doi.org/10.3171/jns.2001.95.2.0268
  13. Matsushima T, Kawashima M, Masuoka J, Mineta T, Inoue T. Transcondylar fossa (supracondylar transjugular tubercle) approache: anatomic basis for the approach, surgical procedures, and surgical experience. Skull base 20:83-91, 2010 https://doi.org/10.1055/s-0029-1242193
  14. Matsushima T, Fukui M. Lateral approaches to the foramen magnum: with special reference to the transcondylar fossa approach and transcondylar approach. Neurol Surg 24:119-24, 1996
  15. Matsushima T, Goto Y, Natori Y, Matsukado K, Fukui M. Surgical treatment of glossopharyngeal neuralgia as vascular compression syndrome via transcondylar fossa (supracondylar transjugular tubercle) approach. Acta Neurochir 142:1359-63, 2000 https://doi.org/10.1007/s007010070005
  16. Matsushima T, Natori Y, Katsuta T, Ikezaki K, Fukui M, Rhoton AL. Microsurgical anatomy for lateral approaches to the foramen magnum with special reference to transcondylar fossa (supracondylar transjugular tubercle) approach. Skull Base Surg 8:119-25, 1998 https://doi.org/10.1055/s-2008-1058570
  17. Matsushima T, Nishiye E, Matsubara T. Clipping of a VA-PICA aneurysm near the midline through transcondylar fossa approach (supracondylar transjugular tubercle approach). Surg Cereb Stroke 25:265-8, 1997 https://doi.org/10.2335/scs1987.25.4_265
  18. Menezes AH. Surgical approaches: postoperative care and complications "posterolateral-far lateral transcondylar approach to the ventral foramen magnum and upper cervical spinal canal." Childs Nerv Syst 24:1203-7, 2008 https://doi.org/10.1007/s00381-008-0597-5
  19. Nourbakhsh A, Katira KM, Notarianni C, Vannemreddy P, Guthikonda B, Nanda A. Long-term follow-up of disability among patients with posterior inferior cerebellar artery aneurysm. J Clin Neurosci 17:980-3, 2010 https://doi.org/10.1016/j.jocn.2009.10.041
  20. Perneczky A. The posterolateral approach to the foramen magnum, in Samii M: Surgery in and Around the Brain Stem and the Third Ventricle: Anatomy, Pathology, Neurophysiology, Diagnosis, Treatment, Berlin, Springer-Verlag, 1986, pp 460-6
  21. Raso JL, Gusmao SN. A new landmark for finding the sigmoid sinus in suboccipital craniotomies. Neurosurgery 68:1-6, 2011 https://doi.org/10.1227/NEU.0b013e318206fe84
  22. Salas E, Sekhar LN, Ziyal IM, Caputy AJ, Wright DC. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg 90:206-19, 1999
  23. Salcman M, Rigamonti D, Numaguchi Y, Sadato N. Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex: variations on a theme. Neurosurgery 27:12-20, 1990 https://doi.org/10.1227/00006123-199007000-00002
  24. Sen C, Shrivastava R, Anwar S, Triana A. Lateral transcondylar approach for tumors at the anterior aspect of the craniovertebral junction. Neurosurgery 66:104-12, 2010 https://doi.org/10.1227/01.NEU.0000365930.95389.60
  25. Tedeschi H, Rhoton AL Jr. Lateral approaches to the petroclival region. Surg Neurol:41:180-216, 1994 https://doi.org/10.1016/0090-3019(94)90123-6