Microsurgical Management of PICA Aneurysms

Sandeep Kandregula, Bharat Guthikonda 
 Department of Neurosurgery, LSU Health Sciences, Shreveport, US

Correspondence Address:
Sandeep Kandregula
Department of Neurosurgery, LSU Health Sciences, Shreveport
US

Full Text

Posterior Inferior cerebellar artery (PICA) aneurysms are the second most common posterior circulation aneurysms after basilar apex aneurysms. Although the PICA aneurysm can be treated by clipping and coiling, sometimes smaller caliber of the PICA, wide neck aneurysms and the mass effect over the adjacent brainstem structures dictates a microsurgical management.

Generally, the proximal PICA aneurysms were managed using the variants of the far lateral and retro sigmoid approaches and distal aneurysms using the midline approaches. Given the vast variations in the origin of the PICA aneurysm from vertebral artery, a careful pre-operative planning is essential. High riding vertebral artery is one of the important variations where a modified retro mastoid craniotomy which enables the access to the glossopharyngeal-acoustic triangle for clipping of the PICA aneurysms along with the proximal and distal control.[1] In this illustration we intend to show the modified retro mastoid craniotomy and the anatomy of glossopharyngeal -acoustic triangle.

Device: I pad pro-12

Software: Procreate

[INLINE:1]

References