Skull Base Surgery of the Posterior Fossa

213

discharge after basilar aneurysm surgery. Krisht
et al. [ 129 ] reported a more recent experience
with the surgical treatment of basilar apex
aneurysms, of which half presented with
SAH. In this cohort, 98% of aneurysms were
successfully clipped. The authors report that
88% of patients had a Glasgow Outcome Scale
score of 4 or 5.

Posterior Inferior Cerebellar Artery
Aneurysms
D’Ambrosio et al. [ 130 ] reviewed a series of 20
patients with PICA aneurysms who were treated
using microsurgery. Most of these patients (16
patients; 80%) presented with SAH. In this

cohort, 93% of patients had a good outcome, and

there were no mortalities. Al-Khayat et al. [ 131 ]

reviewed their experience with 52 aneurysms and

reported good outcomes in 90% of patients, with

a mortality rate of 2%. Williamson et al. [ 132 ]

reported a series of 22 patients with PICA aneu-

rysms from the BRAT cohort. In this group, 19

patients were treated with clipping, 1 died before

treatment, and 2 were treated using an endovas-

cular technique. The authors reported that

although the demographics of patients harboring

PICA aneurysms were not significantly different

than patients who harbored aneurysms at other

locations, these patients had a higher incidence of

poor outcome compared to all other patients

Fig. 14.12 Suboccipital, trans-superior fovea approach to a
dorsal pontine cavernous malformation. A 68-year- old man
presented with acute-onset facial paralysis. (a) Preoperative
axial T1-weighted, (b) sagittal T1-weighted and (c) axial
T1-weighted, magnetic resonance imaging studies demon-
strate a dorsal pontine cavernous malformation at the level
of the facial colliculus. The lesion was approached using a

midline suboccipital telovelar approach and through the

superior fovea safe- entry zone. (d) Postoperative axial

T1-weighted and (e) sagittal T2-weighted magnetic reso-

nance imaging studies demonstrate complete resection of

the lesion. The patient exhibited transient worsening of his

facial weakness but improved to baseline at follow-up (Used

with permission from the Journal of Neurosurgery)

14 Microsurgical Management of Posterior Fossa Vascular Lesions