title: Presigmoid Approach to Vertebrobasilar Artery Aneurysms: A Series of 31 Patients and Review of the Literature.
abstract: OBJECTIVE
  The presigmoid approach can be used to treat vertebrobasilar artery aneurysms when circumstances require more operative exposure. High morbidity and mortality in these cases have been reported. In this study, we describe our modified presigmoid approach for vertebrobasilar artery aneurysms and our clinical results.
  
  
  METHODS
  This series includes patients with vertebrobasilar aneurysms clipped via the modified presigmoid approach at the Department of Neurosurgery at Helsinki University Hospital from 1998 to 2014. Data were collected from the operating record books, patients' medical records, and a radiologic database server.
  
  
  RESULTS
  Thirty-three presigmoid procedures of 31 patients were performed to treat 34 aneurysms (14 ruptured, 20 unruptured). The aneurysms had a mean distance from the posterior clinoid process to the aneurysm neck of 12.2 mm (range, 0-26.6 mm). A favorable outcome was achieved in 21 patients (64%). A favorable outcome was achieved in 74% of unruptured and good-grade patients, whereas favorable outcome was achieved in only 36% of poor-grade patients. Complete or near-complete occlusion was achieved in 79%. Larger aneurysms, fusiform morphology, and anterior dome projection had lower occlusion rates.
  
  
  CONCLUSIONS
  We have described our experiences of using the presigmoid approach to treat vertebrobasilar aneurysms. The clinical and radiographic results are acceptable given the complex location and configuration of the treated aneurysms. Unfavorable outcomes are related to the poor admission Hunt and Hess grade, aneurysm morphology, and aneurysm size.
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: joy_mardjono@yahoo.com.
authors.forename: Mardjono
authors.initials: M
authors.lastname: Tjahjadi
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juri
authors.initials: J
authors.lastname: Kivelev
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Serrone
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Maekawa
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Oleg
authors.initials: O
authors.lastname: Kerro
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hafez
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000473:pathology*
keywords: Angioplasty; Aortic arch reconstruction; Arterial occlusive disease; Intracranial stenting; Mechanical thrombolysis; Stroke