Microsurgical Clipping of Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysm: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E48-E49
Author(s):  
Ricardo Chmelnitsky Wainberg ◽  
Marcos Devanir Silva da Costa ◽  
Yair A Ugalde Hernández ◽  
Ricardo Lourenço Caramanti ◽  
César Augusto Ferreira Alves Filho ◽  
...  
Keyword(s):  
Case Reports ◽  
Posterior Inferior Cerebellar Artery ◽  
Case Series ◽  
Artery Aneurysm ◽  
Close Relation ◽  
Cerebellar Tonsil ◽  
3 Dimensional ◽  
Suboccipital Craniotomy ◽  
Microsurgical Clipping ◽  
Cerebellar Artery

Abstract The distal posterior inferior cerebellar artery (PICA) is a rare site of aneurysm formation. Only small case series and case reports regarding surgical treatment are found in the literature. The PICA is divided into 5 segments (anterior medullary, lateral medullary, tonsilomedullary, telovelotonsillary, and cortical), and the distal ones represent the most complex, due to anatomic variations. We present a case of a 69-yr-old female patient who has suffered from a sudden and intense occipital headache, associated with nausea and vomiting. CT scan showed intraventricular hemorrhage, and further investigation with MRI and MR Angiography revealed a small distal PICA aneurysm, at the superior part of the medial aspect of the left cerebellar tonsil. Digital angiography has demonstrated the aneurysm at the tonsilomedullary segment of the PICA. In this 3-dimensional video, the authors show the microsurgical clipping of a saccular distal PICA aneurysm in the close relation to a choroidal branch, performed by median suboccipital craniotomy. Step-by-step of the dissection, relevant surrounding anatomy and aneurysm clipping is demonstrated. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.

Clip Reconstruction of Large Posterior Inferior Cerebellar Artery Aneurysm: 3-Dimensional Operative Video

2017 ◽  
Vol 14 (5) ◽  
pp. 590-590
Author(s):  
Arnau Benet ◽  
Halima Tabani ◽  
Dylan Griswold ◽  
Sonia Yousef ◽  
Ali Tayebi Meybodi ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
3 Dimensional ◽  
Cerebellar Artery

scholarly journals Far Lateral Approach for Clipping of a Posterior Inferior Cerebellar Artery Aneurysm

2019 ◽  
Vol 80 (S 04) ◽  
pp. S343-S343
Author(s):  
Jaafar Basma ◽  
Vincent N. Nguyen ◽  
William M. Mangham ◽  
Nickalus R. Khan ◽  
Jeffrey Sorenson ◽  
...  
Keyword(s):  
Hypoglossal Nerve ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Lateral Approach ◽  
Microsurgical Anatomy ◽  
Microsurgical Clipping ◽  
Cerebellar Artery ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Clip Occlusion

Abstract Objectives To describe a far lateral approach for microsurgical clipping of a ruptured posterior inferior cerebellar artery (PICA) aneurysm involving the hypoglossal nerve, with emphasis on the microsurgical anatomy, and technique. Design A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses were exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses. The ipsilateral cerebellar tonsil is mobilized and the PICA is followed to its junction with the vertebral artery. Hypoglossal nerve rootlets are draped over the dome of the aneurysm. Mobilization of the PICA and the hypoglossal nerve away from the lateral medulla allows microsurgical clipping of the aneurysm neck. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior authors performed the surgery. The video was edited by Drs. V.N. and J.B. Chart review and literature review were performed by Drs. W.M. and J.B. Outcome Measures Outcome was assessed with successful clip occlusion and postoperative neurological function. Results There was complete clip occlusion of the PICA aneurysm with no postoperative neurological deficits. The patient was discharged home after an uneventful hospital course. Conclusion The far lateral approach provides an adequate corridor to the ventrolateral brainstem for microsurgical treatment of PICA aneurysms. An adequate understanding of the relevant microsurgical anatomy is the key to safe and effective clipping in this region.The link to the video can be found at: https://youtu.be/yhjKRIG5H74.

scholarly journals Tonsillobiventral fissure approach to the lateral recess of the fourth ventricle

2017 ◽  
Vol 127 (4) ◽  
pp. 768-774 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Michael T. Lawton ◽  
Halima Tabani ◽  
Arnau Benet
Keyword(s):  
Fourth Ventricle ◽  
Posterior Inferior Cerebellar Artery ◽  
Angle Of Attack ◽  
Cerebellar Tonsil ◽  
Lateral Recess ◽  
Suboccipital Craniotomy ◽  
Surgical Access ◽  
Cerebellar Artery ◽  
Effective Option ◽  
Perforator Arteries

OBJECTIVESurgical access to the lateral recess of the fourth ventricle (LR) is suboptimal with existing transvermian and telovelar approaches because of limited lateral exposure, significant retraction of the cerebellar tonsil, and steep trajectories near brainstem perforator arteries. The goal in this study was to assess surgical exposure of the tonsillobiventral fissure approach to the LR, and to describe the relevant anatomy.METHODSTwo formaldehyde-fixed cerebella were used to study the anatomical relationships of the LR. Also, the tonsillobiventral fissure approach was simulated in 8 specimens through a lateral suboccipital craniotomy.RESULTSThe pattern of the cerebellar folia and the cortical branches of the posterior inferior cerebellar artery were key landmarks to identifying the tonsillobiventral fissure. Splitting the tonsillobiventral fissure allowed a direct and safe surgical trajectory to the LR and into the cerebellopontine cistern. The proposed approach reduces cervical flexion and optimizes the surgical angle of attack.CONCLUSIONSThe tonsillobiventral fissure approach is a feasible and effective option for exposing the LR. This approach has more favorable trajectories and positions for the patient and the surgeon, and it should be added to the armamentarium for lesions in this location.

Suboccipital Craniotomy and Clip Occlusion of a Precoiled Recurrent Distal Posterior Inferior Cerebellar Artery Aneurysm: Operative Video

2017 ◽  
Vol 13 (6) ◽  
pp. 761-762
Author(s):  
Jonadab Dos Santos Silva ◽  
Hugo L Doria Netto ◽  
Arnau Benet ◽  
Jan-Karl Burkhardt ◽  
Michael T Lawton
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Suboccipital Craniotomy ◽  
Cerebellar Artery ◽  
Clip Occlusion
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