Surgical treatment of a posterior inferior cerebellar artery
A 68-year-old woman presented with a sudden onset of severe headache followed by loss of consciousness. Soon after ictus, she was transferred by ambulance to the emergency department in a county-level hospital. Computed tomography (CT) of the head showed a mild SAH, located predominantly in the posterior fossa. Subsequent 3-dimensional CT angiography revealed a saccular aneurysm at the origin of the left PICA. After a medical treatment, she regained consciousness and was then transferred to our hospital 2 days later. Clinical signs and symptoms included headache and a positive meningeal irritation sign; no other neurological symptoms were found. After extensive discussion with the patient's family, she and her family chose a craniotomy to treat the aneurysm 2 days after admission.

After general anesthesia, she underwent a smaller far-lateral surgical procedure to treat the aneurysm. After opening the dura mater, a rigid endoscope (Aesculap, Germany) was introduced to the operation field, and then, the arachnoid membrane was sharply dissected to expose the left VA and the medulla. After exposing the left VA, the cranial root of PICA, the caudal root of PICA, and lower cranial nerve were identified, and then, a saccular aneurysm was recognized at the origin of the PICA. After carefully exposing the neck of the aneurysm, a mini titanium aneurysm clip was placed at the neck of the aneurysm. Then, the body of the aneurysm was punctured to verify that the clipping was complete. After carefully checking the structures in the lateral perimedullary cistern under neuroendoscopy, the dura was closed, the bone flap was replaced, and the incision was sutured.

The post-operative course was uneventful, and the patient was discharged 2 weeks after surgery. The post-operation image view shows a proper placement of the clip, obliteration of the aneurysm, and the parental artery was unobstructed. The patient was follow-up to 3 months and recovered well after the procedure. Written informed consent was obtained from the patient's family for publication of this case report and the accompanying images. All procedures were approved by the ethics committee of Renmin Hospital of Wuhan University.

Source: Medicine: April 2019 - Volume 98 - Issue 17 - p e15304

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