| VIDEO SECTION-OPERATIVE NUANCES: STEP BY STEP
|Year : 2021 | Volume
| Issue : 4 | Page : 833--836
Modified Retromastoid Approach and Clipping of “High-Riding“ VA-PICA Junction Aneurysm: An Operative Video
Kuntal K Das, Maruti Nandan, Kamlesh S Bhaisora, Arun K Srivastava, Awadhesh K Jaiswal, Sanjay Behari
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Background and Introduction: Clipping an aneurysm on an elongated and tented V4 segment near the origin of the posterior inferior cerebellar artery (high-riding VA-PICA junction aneurysm) can be challenging.
Objective: We demonstrate the microsurgical clipping technique of such an aneurysm using a modified retromastoid approach (MRMA) and glossopharyngeal-cochlear triangle (GCT).
Surgical Technique: A 50-year-old female with a ruptured high-riding left VA-PICA junction aneurysm underwent an MRMA. Using segmental vessel isolation with proximal and distal temporary clips, this aneurysm was occluded through the GCT by applying a tandem clipping technique while preserving the PICA.
Results: The procedure was uneventful. Apart from transient ataxia, she recovered completely and maintains a good status at follow-up.
Conclusion: In high-riding VA-PICA junction aneurysms, a conventional far lateral approach may create awkward viewing and working angles. An MRMA with a horizontal trajectory through the GCT may be a more appropriate strategy.
Dr. Kuntal K Das
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
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