title: Endoscopic endonasal clipping of a ruptured vertebral-posterior inferior cerebellar artery aneurysm: technical case report.
abstract: BACKGROUND
  Aneurysms arising from the vertebral and posterior inferior cerebellar artery complex account for only 0.5 to 3% of all aneurysms. Surgery for these aneurysms is technically challenging because of the deep location and intimate relation with the medulla and lower cranial nerves. The authors report the case of a patient with a right vertebral-posterior inferior cerebellar artery complex (VA-PICA) aneurysm that was successfully clipped via an extended endoscopic endonasal transclival approach.
  
  
  METHODS
  A 74-year-old woman with the sudden onset of severe headache, nausea, and vomiting was admitted to our hospital. A computed tomography (CT) of the brain revealed diffuse subarachnoid hemorrhage associated with intraventricular hemorrhage and incipient hydrocephalus. Cerebral angiography revealed a 1.2-mm aneurysm arising at the origin of the right PICA. The aneurysm was considered unsuitable for selective coil embolization, so neck clipping was performed. With the use of an extended endoscopic endonasal transclival approach, the aneurysm was accurately reached endoscopically and successfully clipped from the parent artery. The patient was discharged neurologically intact.
  
  
  CONCLUSIONS
  To the best of the authors' knowledge, this is the first report of a successfully treated VA-PICA ruptured aneurysm using a pure endoscopic endonasal transclival approach. Endoscopic surgery may be added to the armamentarium of procedures for the treatment of posterior circulation aneurysms.
authors.affiliation: Departments of Neurosurgery, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.forename: Matteo
authors.initials: M
authors.lastname: de Notaris
authors.forename: Moises
authors.initials: M
authors.lastname: Sanchez
authors.forename: Ricard
authors.initials: R
authors.lastname: Valero
authors.forename: Alberto
authors.initials: A
authors.lastname: Prats-Galino
authors.forename: Enrique
authors.initials: E
authors.lastname: Ferrer
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D002526:Cerebellar Diseases / Q000473:pathology / Q000601:surgery*; D002531:Cerebellum / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods*; D012422:Rupture, Spontaneous; D013525:Surgical Instruments