Posterior Inferior Cerebellar Artery Aneurysm: Incidental Aneurysm, Trapping by Microsurgical Clipping, and Resection of the Aneurysm
An otherwise healthy 53-year-old female was diagnosed with an incidental right-sided posterior inferior cerebellar artery (PICA) aneurysm. After significant aneurysm growth on follow-up imaging performed over more than a year, it was decided to offer treatment. After a discussion of multiple treatment strategies, the decision was made to recommend microsurgical clipping of the aneurysm, which was performed in a semi-sitting position via a lower lateral suboccipital approach. Clip reconstruction with various clipping strategies failed, since the aneurysm was partially thrombosed and not saccular but rather a whole parent vessel involvement. Intraoperative ICG angiography revealed retrograde flow in the distal segment of the PICA. Therefore, the decision was made to trap and resect the aneurysm through proximal and distal clipping. The aneurysm sac was then excised and sent for pathological examination. The subsequent postoperative course was uneventful with no neurological deficits. The therapeutic decision-making in the treatment of PICA aneurysm is the main topic of this chapter.
KeywordsPosterior inferior cerebellar artery (PICA) Incidental aneurysm Microsurgical clipping Posterior circulation
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