Modified 'Extended' Suboccipital Subtonsillar Clipping of a Ruptured Proximal Pica Aneurysm: Technical Note with Relevant Anatomical Demonstration
| Autor: | Javier Márquez-Rivas, Alvaro Campero, Magdalena Olivares Blanco, Alberto Di Somma, Juan Emmerich, Antonio López-González, Teresa Somma, Palomares Cancela Caro |
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| Přispěvatelé: | Di Somma, Alberto, Cancela Caro, Palomare, Blanco, Magdalena Olivare, Somma, Teresa, López-González, Antonio, Campero, Alvaro, Emmerich, Juan, Márquez-Rivas, Javier |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Subarachnoid hemorrhage Vertebral artery medicine.medical_treatment Aneurysm Ruptured Proximal PICA aneurysm Neurosurgical Procedures 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Cerebellum medicine.artery medicine Humans PICA aneurysm medicine.diagnostic_test business.industry Intracranial Aneurysm Arteries Clipping (medicine) Middle Aged medicine.disease Neurovascular bundle Occipital condyle Cranial base surgery Vascular surgery Posterior inferior cerebellar artery medicine.anatomical_structure Vascular control Surgery Suboccipital subtonsillar Neurology (clinical) Radiology business 030217 neurology & neurosurgery Cerebral angiography |
| Zdroj: | World Neurosurgery. 117:301-308 |
| ISSN: | 1878-8750 |
| Popis: | Background and Importance Lesions located lateral to the lower brainstem, such as proximal posterior inferior cerebellar artery (PICA) aneurysms, are surgically challenging. We report a case of a patient with a left proximal PICA aneurysm that was successfully clipped via a so-called “extended” suboccipital subtonsillar approach, which allowed us to obtain proper vascular control without removal of the atlas. The anatomy relevant for this approach has been studied. Methods Three adult cadaveric heads were studied. The relevant neurovascular anatomy related to this approach was exposed. Hence, this technique was applied on the patient herewith reported. Case Presentation A 60-year-old man with sudden onset of severe headache, nausea, and vomiting was admitted to our hospital. Computed tomography of the brain showed diffuse subarachnoid hemorrhage, mainly distributed at the level of the perimesencephalic cisterns. Cerebral angiography revealed a 3-mm aneurysm arising at the origin of the left PICA. The aneurysm was considered unsuitable for coil embolization, so it was treated via a “modified” posterolateral suboccipital subtonsillar route. The modification consisted of accomplishing proper proximal vascular control at the extracranial segment of the vertebral artery (V3), without the need of further removal of the posterior portion of the atlas. The patient was discharged neurologically intact. Conclusions The technique we suggested allowed no unnecessary removal of bone, with no need to drill the occipital condyle or remove the atlas, offered proper proximal vascular control in the early stage of the surgical procedure, and limited the quantity of temporary vascular clips inside the intracranial surgical field. |
| Databáze: | OpenAIRE |
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