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Neurosurgery:
doi: 10.1227/NEU.0000000000000284
Operative Technique

The Anterior Temporal Approach for Microsurgical Thromboembolectomy of an Acute Proximal Posterior Cerebral Artery Occlusion

Goehre, Felix MD*; Kamiyama, Hiroyasu MD; Kosaka, Akira MD; Tsuboi, Toshiyuki MD; Miyata, Shiro MD; Noda, Kosumo MD; Jahromi, Behnam Rezai MB§; Ohta, Nakao MD; Tokuda, Sadahisa MD; Hernesniemi, Juha MD, PhD§; Tanikawa, Rokuya MD

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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.

CONCLUSION: 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.

ABBREVIATIONS: ICG, indocyanine green

mRS, modified Rankin scale

P1, precommunicating segment of posterior cerebral artery

PCA, posterior cerebral artery

r-tPA, recombinant tissue plasminogen activator

Copyright © by the Congress of Neurological Surgeons

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