Far-lateral approach without C1 laminectomy for microsurgical treatment of vertebral artery and proximal posterior inferior cerebellar artery aneurysms: Experience from 48 patients

Kitiporn Sriamornrattanakul; Nasaeng Akharathammachote; Areeporn Chonhenchob; Atithep Mongkolratnan; Nattawut Niljianskul; I-Sorn Phoominaonin; Chanon Ariyaprakai

doi:10.1016/j.wnsx.2023.100216

Far-lateral approach without C1 laminectomy for microsurgical treatment of vertebral artery and proximal posterior inferior cerebellar artery aneurysms: Experience from 48 patients

World Neurosurg X. 2023 May 12:19:100216. doi: 10.1016/j.wnsx.2023.100216. eCollection 2023 Jul.

Authors

Kitiporn Sriamornrattanakul¹, Nasaeng Akharathammachote¹, Areeporn Chonhenchob¹, Atithep Mongkolratnan¹, Nattawut Niljianskul¹, I-Sorn Phoominaonin¹, Chanon Ariyaprakai¹

Affiliation

¹ Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.

Abstract

Background: In the endovascular era, most of vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms were mainly treated with endovascular procedures. This study aimed to demonstrate the microsurgical treatment via the far-lateral approach without C1 laminectomy and its clinical outcomes.

Methods: Forty-eight patients with VA and proximal PICA aneurysms treated by microsurgery through the far-lateral approach without C1 laminectomy, between January 2016 and June 2021, were retrospectively evaluated.

Results: Most patients (87.5%) presented with subarachnoid hemorrhage. Grading at presentation was poor in 41.7%. The rates of VA dissecting aneurysms, saccular aneurysms of the VA-PICA junction, and true PICA saccular aneurysms were 54.2, 18.7, and 14.6%, respectively. All aneurysms were located above the lower margin of the foramen magnum. The far-lateral approach without C1 laminectomy was successfully used in all patients without residual aneurysms. Various surgical strategies were applied depending on the characteristics of the aneurysm. Good outcomes 3 months postoperatively were achieved in 77.1% and 89.3% for the overall and good-grade groups, respectively.

Conclusions: Microsurgery is a safe and effective treatment of VA and proximal PICA aneurysms. Moreover, the far-lateral approach without C1 laminectomy was adequate and effective for aneurysms located above the lower border of the foramen magnum.

Keywords: C1 laminectomy; Far-lateral approach; PICA aneurysm; Vertebral artery aneurysm.