Microsurgical Clipping of a Posterior Inferior Cerebellar Artery Aneurysm Following Failed Pipeline Stent

Abstract

Aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with limited consensus on appropriate management. These aneurysms have been noted to have a faster growth rate and are more prone to rupture. Accessing these aneurysms for microsurgical clipping is challenging, and has traditionally required significant removal of the occipital condyle, putting the patient at risk for future complications. Therefore, some have opted to utilize minimally invasive techniques such as a pipeline stent, though these methods can fail to cause complete occlusion of the aneurysm. The current case describes a patient who was found to have a PICA aneurysm that was initially managed with a pipeline stent. However, upon further follow up, the aneurysm showed continued filling, leading to the decision to clip the aneurysm. In this case, we describe the use of a far lateral approach for accessing and clipping a PICA aneurysm with minimal removal of the occipital condyle. The patient successfully tolerated the surgery and was discharged home.

The safety and utility of the semi-sitting position for clipping of posterior circulation aneurysms

“…Several positions have been described for surgical clipping of aneurysms in the posterior cerebral circulation, including the supine position, prone position, and the three-quarter prone position (also known as the park bench position) [7][8][9][10]. The semisitting position has been used with increasing frequency to manage various pathologies in the posterior cranial fossa, mainly for the resection of tumors, such as vestibular schwannomas, tumors in the pineal region, or tumors in the fourth ventricle [11][12][13][14][15][16][17],…”

“Modified Half Pterional Transylvian and Half Subtemporal Approach” for Microsurgical Clipping of Superior Cerebellar Artery Aneurysm Treated With Previous Endovascular Flow-Diverting Stent: 2-Dimensional Operative Video

“…1-8 The understanding of microsurgical anatomy and its application to complex skull base and revascularization techniques are critical for treating posterior circulation aneurysms that have undergone prior flow diversion. 9-13 We describe the case of a 46-year-old woman who previously underwent endovascular flow diversion for an unruptured right superior cerebellar artery (SCA) aneurysm with persistent aneurysm filling over a 4-year period. Because the superior cerebellar artery originated from the neck of the aneurysm and she had prior thromboembolic complications from flow diversion, repeat endovascular treatment was deemed less favorable than microsurgical clipping.…”