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Video Abstract
2020
:11;
84
doi:
10.25259/SNI_78_2020
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Interhemispheric transcallosal transforaminal approach for decompression of a giant superior cerebellar artery thrombosed aneurysm: Three-dimensional operative video

Department of Neurosurgery, Federal University of São Paulo, Napoleao de Barros 715 6 Andar, São Paulo, Brazil.
Corresponding author: Juan Leonardo Serrato-Avila, Department of Neurosurgery, Federal University of São Paulo, Napoleao de Barros 715 6 Andar, São Paulo-04024-002, São Paulo, Brazil. jls_avila@hotmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Serrato-Avila JL, Da Costa MD, Frudit ME, Carrasco-Hernandez JP, Alejandro SA, Chaddad-Neto F. Interhemispheric transcallosal transforaminal approach for decompression of a giant superior cerebellar artery thrombosed aneurysm: Three-dimensional operative video. Surg Neurol Int 2020;11:84.

Abstract

Background:

Giant brain aneurysms account for approximately 5% of all intracranial aneurysms, often presenting with intraluminal thrombosis that causes a mass effect in surrounding neural structures. Although its exact growing mechanism remains unknown, they have to be treated. Despite the most recent advances in neurosurgical fields, the best treatment modality remains unknown and surgery of giant superior cerebellar artery (SCA) aneurysms still is a challenge even for the most experienced neurosurgeons, due to their deep location, surrounding perforating vessels, and intraluminal thrombosis.

Case Description:

In this video, we present the case of a 65-year-old woman with progressive hemiparesis and paresis of low cranial nerves. The symptoms were caused by a giant aneurysm located in the origin of the SCA. Despite endovascular embolization of the aneurysm and placement of a flow diverter stent, the aneurysm increased in size causing symptoms progression. In that scenario, we decided to perform a microsurgical decompression of the aneurysm thrombus and coagulation of the vasa vasorum, to reduce the mass effect and prevent the aneurysm from keep growing.

Conclusion:

Through an extensive description of the surgical anatomy, we illustrate an interhemispheric transcallosal transforaminal approach, with the removal of anterior thalamic tubercle to widely expose the aneurysm dome. The surgery was successfully performed, and the patient symptoms improved. The patient signed the Institutional Consent Form, which allows the use of her images and videos for any type of medical publications in conferences and/or scientific articles.

Keywords

Decompression
Giant aneurysm
Interhemispheric transcallosal transforaminal
SCA
Surgical approach

Annotations: [1,2,3,4]

1) 00:12– Case Description

2) 00:23 – Pre Operative images

3) 02:06 – Patient position

4) 02:40 – Interhemispheric fissure dissection

5) 03:40 – Cingulum gyrus resection

6) 03:59 – Corpus callosotomy

7) 04:52 – Thalamus anterior tubercule resection

8) 05:17 – Thrombectomy

9) 09:17 – Post Operative MRI

[Video 1]-Available on:

www.surgicalneurologyint.com

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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