Based on the relationship between the posterior clinoid process and the basilar artery (BA) apex it may be difficult to obtain proximal control of the BA using temporary clips. Endovascular BA temporary balloon occlusion (TBO) can reduce aneurysm sac pressure, facilitate dissection/clipping, and finally lower the risk of intraoperative rupture. We present our experience with TBO during aneurysm clipping of posterior circulation aneurysms within the setting of a hybrid operating room (hOR). We report one case each of a basilar tip, posterior cerebral artery, and superior cerebellar artery aneurysm that underwent surgical occlusion under TBO within an hOR. Surgical exposure of the BA was achieved with a pterional approach and selective anterior and posterior clinoidectomy. Intraoperative digital subtraction angiography (iDSA) was performed prior, during, and after aneurysm occlusion. Two patients presented with subarachnoid hemorrhage and one patient presented with an unruptured aneurysm. The intraluminal balloon was inserted through the femoral artery and inflated in the BA after craniotomy to allow further dissection of the parent vessel and branches needed for the preparation of the aneurysm neck. No complications during balloon inflation and aneurysm dissection occurred. Intraoperative aneurysm rupture prior to clipping did not occur. The duration of TBO varied between 9 and 11 min. Small neck aneurysm remnants were present in two cases (BA and PCA). Two patients recovered well with a GOS 5 after surgery and one patient died due to complications unrelated to surgery. Intraoperative TBO within the hOR is a feasible and safe procedure with no additional morbidity when using a standardized protocol and setting. No relevant side effects or intraoperative complications were present in this series. In addition, iDSA in an hOR facilitates the evaluation of the surgical result and 3D reconstructions provide documentation of potential aneurysm remnants for future follow-up.

中文翻译：

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血管内临时球囊闭塞术用于后循环动脉瘤的显微外科手术切除。

基于后斜突和基底动脉（BA）根尖之间的关系，可能很难使用临时夹子获得BA的近端控制。血管内BA暂时性球囊闭塞（TBO）可以降低动脉瘤囊压力，促进解剖/夹闭，并最终降低术中破裂的风险。我们将在混合手术室（hOR）设置的后循环动脉瘤夹层动脉瘤期间介绍TBO的经验。我们报告了一个案例，分别在hOR内在TBO下进行了手术闭塞的基底尖端，脑后动脉和小脑上动脉瘤。BA的外科手术暴露是通过翼状入路和选择性的前，后椎体切除术实现的。术前进行数字减影血管造影（iDSA），在动脉瘤闭塞期间和之后。2例蛛网膜下腔出血，1例动脉瘤未破裂。开颅手术后，将腔内球囊穿过股动脉插入并在BA中充气，以进一步解剖准备血管瘤颈所需的亲代血管和分支。在球囊充气和动脉瘤清扫过程中未发生并发症。夹钳前未发生术中动脉瘤破裂。TBO的持续时间在9至11分钟之间变化。小颈动脉瘤残留存在两个案例（BA和PCA）。两名患者术后GOS 5恢复良好，一名患者因与手术无关的并发症死亡。在hOR内进行术中TBO是一种可行且安全的程序，使用标准方案和设置时无其他并发症。在该系列中没有相关的副作用或术中并发症。此外，在hOR中的iDSA有助于评估手术结果，而3D重建则提供了可能的动脉瘤残余物的记录，以备将来之用。