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VIDEO SECTION-OPERATIVE NUANCES: STEP BY STEP
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 833--836

Modified Retromastoid Approach and Clipping of “High-Riding“ VA-PICA Junction Aneurysm: An Operative Video

Kuntal K Das, Maruti Nandan, Kamlesh S Bhaisora, Arun K Srivastava, Awadhesh K Jaiswal, Sanjay Behari 
 Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Kuntal K Das
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
India

Background and Introduction: Clipping an aneurysm on an elongated and tented V4 segment near the origin of the posterior inferior cerebellar artery (high-riding VA-PICA junction aneurysm) can be challenging. Objective: We demonstrate the microsurgical clipping technique of such an aneurysm using a modified retromastoid approach (MRMA) and glossopharyngeal-cochlear triangle (GCT). Surgical Technique: A 50-year-old female with a ruptured high-riding left VA-PICA junction aneurysm underwent an MRMA. Using segmental vessel isolation with proximal and distal temporary clips, this aneurysm was occluded through the GCT by applying a tandem clipping technique while preserving the PICA. Results: The procedure was uneventful. Apart from transient ataxia, she recovered completely and maintains a good status at follow-up. Conclusion: In high-riding VA-PICA junction aneurysms, a conventional far lateral approach may create awkward viewing and working angles. An MRMA with a horizontal trajectory through the GCT may be a more appropriate strategy.


How to cite this article:
Das KK, Nandan M, Bhaisora KS, Srivastava AK, Jaiswal AK, Behari S. Modified Retromastoid Approach and Clipping of “High-Riding“ VA-PICA Junction Aneurysm: An Operative Video.Neurol India 2021;69:833-836


How to cite this URL:
Das KK, Nandan M, Bhaisora KS, Srivastava AK, Jaiswal AK, Behari S. Modified Retromastoid Approach and Clipping of “High-Riding“ VA-PICA Junction Aneurysm: An Operative Video. Neurol India [serial online] 2021 [cited 2021 Oct 16 ];69:833-836
Available from: https://www.neurologyindia.com/article.asp?issn=0028-3886;year=2021;volume=69;issue=4;spage=833;epage=836;aulast=Das;type=0