Microsurgical Clipping of a Complex PICA Aneurysm

  • Katherine Elizabeth Wagner
  • Amir Reza Dehdashti

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This video details the microsurgical clipping of a complex, partially calcified, unruptured left posterior inferior cerebellar artery (PICA) aneurysm. After discussion of the clinical presentation, the relevant anatomy is reviewed and the role of imaging, including MRI/MRA and digital subtraction angiography, in preoperative evaluation is explained. The video then documents the entire procedure step by step, illustrating clip placement and highlighting measures to ensure a successful outcome, including the use of intraoperative angiography to confirm complete occlusion of the aneurysm.


This video provides an overview of the information to be presented in the following sequences

About The Author

Katherine Elizabeth Wagner

Katherine E. Wagner, MD , graduated from New Jersey Medical School, Newark, NJ, in 2014 and is currently a neurosurgical resident on the Hofstra/Northwell Neurosurgical Residency Program (in-folded fellowship in Neuro-oncology, July 2017 to June 2018). She also holds a BA in Chemistry, cum laude, from Wellesley College, Wellesley, MA. Dr. Wagner has extensive teaching experience and has published in peer-reviewed journals. She is a resident member of the Congress of Neurological Surgeons.

Amir Reza Dehdashti

Amir R. Dehdashti, MD, FACS, FMH , is Director of Cerebrovascular Neurosurgery Research at North Shore University Hospital, Manhasset, NY, and an Associate Professor in the Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell School of Medicine. Dr. Dehdashti is a board member of the North American Skull Base Society and current Chair of the society’s Annual Meeting Program. He is Editor-in-Chief of Acta Video Channel, Associate Editor of Skull Base Video Journal, and an editorial board member for several journals. He is the author of almost 100 peer-reviewed publications. He has delivered numerous oral presentations across the world and has been an invited lecturer, instructor, or moderator both nationally and internationally.


About this video

Katherine Elizabeth Wagner
Amir Reza Dehdashti
Online ISBN
Total duration
10 min
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

[MUSIC PLAYING] Here, we describe the microsurgical clipping of the complex PICA aneurysm. This aneurysm was diagnosed in a 65-year-old woman who presented to the emergency with headache and some dizziness. After discussion of treatment versus observation, we decided for treatment.

The aneurysm is large and, therefore, we temporary clip, under burst suppression, the vertebral artery. Once the first clip is positioned, we check, confirm the patency of the distal vertebral artery. Once we are sure, we add another clip on top of the first one. After final dissection around the dome, we add a third clip as a final booster clip to completely eliminate the flow in the aneurysm.