{"id":"6bf4be5b-4d6b-4fa8-aee3-623c06c2f0da","slug":"combined-transpetrosal-transtentorial-approach-with-occipital-artery-anterior-inferior-cerebellar-artery-bypass-and-aneurysm-clipping-for-a-lower-basilar-artery-aneurysm-involving-anterior-i","title":"Combined transpetrosal-transtentorial approach with occipital artery – anterior inferior cerebellar artery bypass and aneurysm clipping for a lower basilar artery aneurysm involving anterior inferior cerebellar artery: Two-dimensional operative video","authors":["Gahn Duangprasert","Nakao Ota","Kosumo Noda","Rokuya Tanikawa"],"abstract":"Background: Aneurysms of the lower basilar artery (BA) are rare, accounting for <1% of all intracranial aneurysms. This location has been described as “No man’s land” since it poses a potential challenge for microsurgery. Recently, endovascular treatment has become an alternative option; however, there are some disadvantages regarding the obliteration rate, patency of the parent, and perforating arteries. Case Description: We present the case of a 69-year-old female with an incidentally found lower BA aneurysm. The imaging examinations revealed a wide-neck aneurysm size of 8.5 mm arising just distal to the vertebrobasilar junction, with involvement of the left anterior inferior cerebellar artery (AICA). After a discussion with the patient, she opted to undergo the surgical treatment. We described the detailed steps of our surgical techniques in performing a combined transpetrosal-transtentorial approach. First, the occipital artery (OA) was harvested. Then, the posterior transpetrosal (retrolabyrinthine) and a far-lateral suboccipital approach were conducted with tentorial sectioning to expose the aneurysm. After AICA was confirmed to arise from the aneurysm sac, the OAAICA bypass was established to ensure AICA patency, followed by complete aneurysm clipping. The approach provided both the presigmoid and retrosigmoid corridors for bypass and clipping procedures, respectively. The patient tolerated the procedure well. Postoperative imaging examinations showed complete aneurysm obliteration and bypass patency without complications. She was discharged without neurological deficits (modified Rankin Scale 0). Conclusion: The combined transpetrosal approach is safe and effective for revascularization and clipping procedure for a lower BA aneurysm. 00:10 Clinical presentation and neuroimagings 01:10 Rationale of the procedure 02:09 Alternative options 02:41 Risks and benefits of the procedure 02:53 Positioning and key surgical steps 03:05 Operation and OA harvesting 03:40 Suboccipital muscles layer-by-layer dissection 04:46 Translabyrinthine approach 07:46 Transcondylar approach 08:31 Aneurysm clipping 09:21 Disease background The Institutional Review Board approval is not required. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs. A fellowship from the Takeda Science Foundation supports Gahn Duangprasert.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/neurovascular.png","publishDate":"2024-11-15T00:00:00.000Z","doi":"10.25259/SNI_884_2024","categories":["Neurovascular","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/6bf4be5b-4d6b-4fa8-aee3-623c06c2f0da/pdf"}