Cerebellar Artery Aneurysm |
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Case #100: Flow-Assisted Neurosurgery
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Courtesy F.T. Charbel, MD, Associate Professor, Dept. of Neurosurgery
University of IL at Chicago
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Introduction |
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A 76-year-old female patient presented with headaches and diplopia.
Cerebral angiography and MRI confirm a giant right cerebellar aneurysm.
An attempt to coil the aneurysm was unsuccessful. The patient was scheduled for surgery the following morning.
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Pre-surgery MRI
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Pre-surgery
angiogram
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Aneurysm Exposure |
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The aneurysm was approached through a right pterional craniotomy.
Meticulous dissection exposed the aneurysm. The surgeon identified the vessels at risk of being compromised by the
clip as the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) on the right side.
The diameter of these vessels were measured with a gauge and the appropriate size flowprobe was selected.
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Baseline Flow Measurements |
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The Charbel MicroflowprobeTM was placed on the SCA and baseline flow was recorded. The probe was then placed on the PCA and baseline flow was recorded.
SCA baseline flow measured 16-18 ml/min
PCA baseline flow measured 34-36 ml/min.
If cerebral protective agents are administered, baseline flows are measured after their administration since
baseline blood flow decreases about 40% in response to the reduced metabolic demands.
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SCA baseline flow: 16-18 ml/min
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PCA baseline flow: 34-36 ml/min
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Post-Clip Flow Measurements |
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Following aneurysm clipping, flows were agin measured. Flow in the SCA
dropped to 2-4 ml/min, less than 25% of its baseline value. PCA flow increased to 55-60 ml/min.
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The SCA was found to be partially incorporated in the clip.
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SCA flow: 2-4 mL/min
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Post-Clip Adjustment Flow Measurements |
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The clip was repositioned. Following repositioning, flow in both the SCA
and PCA returned to baseline levels.
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SCA kinked by clip
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After the clip was repositioned, SCA
flow was restored to baseline levels.
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Summary |
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Flow-based aneurysm clipping with the Charbel Micro-FlowprobeTM played an crucial role in assuring a good outcome in this case. By comparing actual flow values before and after clipping of the aneurysm, the surgeon was able to determine that flow in the SCA was severely compromised following initial clipping. After the clip was adjusted, flow measurements confirmed that SCA flow had returned to baseline levels.
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Post-clip angiogram
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