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Acta Neurochirurgica

, Volume 161, Issue 8, pp 1529–1533 | Cite as

Clipping of a PICA aneurysm located on the contralateral side of its parent vertebral artery in front of the brainstem: how I do it

  • Michel W. BojanowskiEmail author
  • Pascale Lavoie
  • Elsa Magro
How I Do it - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm

Abstract

Background

Vertebro-PICA aneurysms may be challenging because of their relationship with the brainstem and the lower cranial nerves, especially when the vertebral artery is tortuous and the aneurysm is located in front of the brainstem, contralaterally to the parent vertebral artery. We describe the surgical technique for safe approach.

Method

Cadaveric dissection performed by the authors, provided comprehensive understanding of relevant anatomy. Intraoperative photos and videos show clipping of the aneurysm using a combined midline and far-lateral suboccipital craniotomy with a para-condylar extension. The literature reviews potential complications.

Conclusion

This combined approach allows safe clipping of such PICA aneurysms.

Keywords

PICA aneurysms Contralateral approach Far-lateral approach Para-condylar extension 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

References

  1. 1.
    Brag TM, Duckworth EAM (2008) Contralateral far-lateral approach for clipping of a ruptured vertebral artery-posterior inferior cerebellar artery aneurysm. Neurosurg Focus 25(6):E9CrossRefGoogle Scholar
  2. 2.
    Campero A, Rubino P, Rhoton AL. Anatomy of the vertebral artery. In Bruneau,George, Spetzler, eds. Pathology and Surgery around the Vertebral Artery. Paris: Springer; 2011:29–40Google Scholar
  3. 3.
    Kawase T, Bertalanffy H, Otani M, Shiobara R, Toya S (1996) Surgical approaches for vertebro-basilar trunk aneurysms located in the midline. Acta Neurochir 138(4):402–410CrossRefGoogle Scholar
  4. 4.
    Matsushima T, Natori Y, Katsuta T, Ikezaki K, Fukui M, Rhoton AL (1998) Microsurgical anatomy for lateral approaches to the foramen magnum with special reference to transcondylar fossa (supracondylar transjugular tubercle) approach. Skull Base Surg 8(3):119–125CrossRefGoogle Scholar
  5. 5.
    Matsushima T, Matsukado K, Natori Y, Inamura T, Hitotsumatsu T, Fukui M (2001) Surgery on a saccular vertebral artery-posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach: surgical results and indications for using two different lateral. J Neurosurg 95(2):268–274CrossRefGoogle Scholar
  6. 6.
    Matsushima K, Funaki T, Komune N, Kiyosue H, Kawashima M, Rhoton AL (2015) Microsurgical anatomy of the lateral condylar vein and its clinical significance. Neurosurgery 11(Suppl 2):135–145 discussion 145–6 Google Scholar
  7. 7.
    Rhoton AL (2000) The foramen magnum. Neurosurgery 47(3 Suppl):S155–S193Google Scholar
  8. 8.
    Rohde V, Schaller C, Hassler W (1994) The extreme lateral transcondylar approach to aneurysms of the vertebrobasilar junction, the vertebral artery, and the posterior inferior cerebellar artery. Skull Base Surg 4(4):177–180CrossRefGoogle Scholar
  9. 9.
    Taguchi Y, Hoshikawa Y, Tanaka K, Miyakita Y, Morishima H, Sekino H (1996) Contralateral transcondylar approach for aneurysms of the posterior inferior cerebellar artery-vertebral artery complex. J Clin Neurosci 3(2):156–161CrossRefGoogle Scholar
  10. 10.
    Troude L, Bernard F, Sy ECN, Roche PH (2019) The modified retrosigmoid approach: a how I do it. Acta Neurochir 161(2):417–423CrossRefGoogle Scholar
  11. 11.
    Wen HT, Rhoton AL, Katsuta T, de Oliveira E (1997) Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87(4):555–585CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of NeurosurgeryCentre Hospitalier de l’Université de MontréalMontrealCanada
  2. 2.Division of NeurosurgeryCHU de Quebec, Hôpital l’Enfant JésusQuebecCanada
  3. 3.Department of NeurosurgeryUniversity Hospital of BrestBrestFrance
  4. 4.LaTIM, INSERM, UMR 1011ParisFrance

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