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- Department of Neurosurgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathum Thani, Thailand
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
Correspondence Address:
Rokuya Tanikawa, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan.
DOI:10.25259/SNI_884_2024
Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Gahn Duangprasert1, Nakao Ota2, Kosumo Noda2, Rokuya Tanikawa2. 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. 15-Nov-2024;15:425
How to cite this URL: Gahn Duangprasert1, Nakao Ota2, Kosumo Noda2, Rokuya Tanikawa2. 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. 15-Nov-2024;15:425. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13217
Date of Submission
21-Oct-2024
Date of Acceptance
30-Oct-2024
Date of Web Publication
15-Nov-2024
Abstract
Background: Aneurysms of the lower basilar artery (BA) are rare, accounting for
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.
Keywords: Aneurysm, Anterior inferior cerebellar artery, Basilar artery, Occipital artery, Revascularization, Transpetrosal
Video 1
Annotations[1-8]
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
06:38 OA-AICA bypass
07:46 Transcondylar approach
08:31 Aneurysm clipping
09:21 Disease background
09:47 Outcome
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
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.
Disclaimer
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.
Acknowledgement
A fellowship from the Takeda Science Foundation supports Gahn Duangprasert.
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