POSTERIOR COMMUNICATING ARTERY ANEURYSM CLIPPING FOR THE NEW BEGINNERS: This 84-years-old morbid obese female patient with a history of cardiac disease was admitted on the 6th day of subarachnoid hemorrhage. She was clinically WFNS grade 2. CT can showed hydrocephalus. DSA of the patient revealed a wide-necked 6 aneurysm on the right Pcom artery. Pcom itself was fetal type. Because of extreme proximal tortuosity endovascular coiling was not possible unless we try to gain access through cervical carotid puncture. Right pterional approach was performed. There are many surgeons who would not spilt the Sylvian fissure for a pcom aneurysm but there are also many who would do so. Opening the fissure provides wide working area makes visualization of the anterior choroidal artey easier and if any retraction is required the vector of the retraction force becomes inferior to superior rather than compressive. The vessels of the elderly are almost always calcified and application of a temporary clip may run the risk of plaque rupture and embolus. Our first attempt at clipping with a 9mm straight clip resulted in slippage of the clip. Second attempt under temporary cliping again caused slippage. The problem was solved with a side-angled clip which sealed the aneurysn whilst preserving the fetal pcom and the anterior choroidal arteries. Because of technical problems we were not able to perform ICG videoangiography but confirmed patency of the vessels with doppler. The patient did OK
Posted on: Fri, 11 Jul 2014 11:11:11 +0000
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