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



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.


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.


This combined approach allows safe clipping of such PICA aneurysms.


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


Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.


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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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