title: The anterior temporal approach for microsurgical thromboembolectomy of an acute proximal posterior cerebral artery occlusion.
abstract: BACKGROUND
  In a short window of time, intravenous and intra-arterial thrombolysis is the first treatment option for patients with an acute ischemic stroke caused by the occlusion of one of the major brain vessels. Endovascular treatment techniques provide additional treatment options. In selected cases, high revascularization rates following microsurgical thromboembolectomy in the anterior circulation were reported. A technical note on successful thromboembolectomy of the proximal posterior cerebral artery has not yet been published.
  
  
  OBJECTIVE
  To describe the technique of microsurgical thromboembolectomy of an acute proximal posterior cerebral artery occlusion and the brainstem perforators via the anterior temporal approach.
  
  
  METHODS
  The authors present a technical report of a successful thromboembolectomy in the proximal posterior cerebral artery. The 64-year-old male patient had an acute partial P1 thromboembolic occlusion, with contraindications for intravenous recombinant tissue plasminogen activator. The patient underwent an urgent microsurgical thromboembolectomy after a frontotemporal craniotomy.
  
  
  RESULTS
  The postoperative computerized tomography angiography showed complete recanalization of the P1 segment and its perforators, which were previously occluded. The early outcome after 1 month and 1 year follow-ups showed improvement from modified Rankin scale 4 to modified Rankin scale 1.
  
  
  CONCLUSIONS
  Microsurgical thromboembolectomy can be an effective treatment option for proximal occlusion of the posterior cerebral artery in selected cases and experienced hands. Compared with endovascular treatment, direct visual control of brainstem perforators is possible.
authors.affiliation: *Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany; ‡Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan; §Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Felix
authors.initials: F
authors.lastname: Goehre
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.forename: Akira
authors.initials: A
authors.lastname: Kosaka
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.forename: Nakao
authors.initials: N
authors.lastname: Ohta
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
mesh_terms: D017128:Embolectomy / Q000379:methods*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D020769:Posterior Cerebral Artery; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome