Speakers

Treatment of complex cerebral aneurysms
1108 09:50-10:00
Cerebrovascular/304B
【Introduction】 Among cerebral aneurysms, those that cannot be treated with standard clipping or endovascular treatment are generally considered to be complex cerebral aneurysms. Specifically, giant/thrombosed aneurysms and aneurysms that require reconstruction of branches are very rare, accounting for approximately 5% of total aneurysms. Direct surgical treatment for these special aneurysms can be divided into three types: 1) clipping or trapping using bypass or thrombus removal (Method 1), 2) bypass + proximal or distal parent artery occlusion. These are so-called flow alteration techniques, which induce thrombosis in the aneurysm (Method 2). 3) Hybrid treatment: A combination of direct surgery and endovascular treatment, which sometimes corresponds to bypass combined endovascular treatment (Method 3). Here, we present the treatment methods and outcomes for these complex aneurysms performed at our hospital. 【Subjects】 Of 681 cases of cerebral aneurysms treated by direct surgery at our hospital from 2000 to December 2023, 66 cases (9.7%) could not be treated by clipping. Thirty- eight cases were treated by method 1, 16 by method 2, and 12 by method 3. 【Results】 Two ischemic complications were observed in the cases treated by method 1, and two cases of method 2. One case of method 3 showed ischemic complications on imaging, but this did not affect the outcome. No cases ruptured after treatment. 【Discussion and conclusion】 If clipping or trapping is finally possible in combination with bypass or endovascular procedures, a cure can be expected. The flow alteration method for intracranial aneurysms needs to be selected carefully because of the uncertainty of the therapeutic effect.

Transpetrosal approach for the petrous apex lesion
1110 12:00-13:00
Luncheon Symposium/305
With the development of less invasive treatment modalities (medication, endovascular treatment, and radiation therapy), open surgery becomes less common. However, complex tumor and vascular cases, which could be treated only with open surgeries do exist and the surgeons should try not only to keep the quality of surgeries but also to improve it. Petrosal approach is one of the most complex skull base surgeries, but we should try to master it efficiently with less cases. For that purpose, we can integrate the recent advancement in neurosurgical technologies and techniques. Preoperative surgical simulation with high resolution 3-dimensional fusion images makes surgical planning much easier and makes surgery itself simpler and safer. Simplified drilling strategy (mini-combined approach) with quick sinus exposure leads to the shorter operation time and more room for the intradural maneuvers. Newly developed hemostatic devices and agents help us to stop bleeding quickly and keep the surgical field clean. Using these modern technologies and techniques, approach to the petrous apex becomes easier but dissection of tumor from surrounding vital tissues still requires some skills and the judgement of dissection plane and the extent of resection require some experience. I will present how to manage petrous apex lesions in my institute with some illustrative cases.