title: Far-lateral approach for surgical treatment of fusiform PICA aneurysm.
abstract: Ruptured fusiform posterior inferior cerebellar artery (PICA) aneurysms can be technically challenging lesions. Surgeons must be ready to employ a variety of strategies in the successful treatment of these aneurysms. Strategies include complex clip techniques including clip-wrapping or trapping and revascularization. The case presented here is of a man with subarachnoid hemorrhage from a fusiform ruptured PICA aneurysm. The technique demonstrated is a far-lateral approach and a clip-wrap technique using muslin gauze. The patient was given aspirin preoperatively in preparation for possible occipital-PICA bypass if direct repair was not feasible. It is the authors' preference to perform direct vessel repair as a primary goal and use bypass techniques when this is not possible. Vessel patency was evaluated after clip-wrapping using intraoperative Doppler. Intraoperative somatosensory and motor evoked potential monitoring is used in such cases. The patient recovered well. The video can be found here: http://youtu.be/iwLqufH47Ds .
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
authors.forename: Jayson A
authors.initials: JA
authors.lastname: Neil
mesh_terms: D000783:Aneurysm / Q000150:complications / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000601:surgery*; D002531:Cerebellum / Q000098:blood supply / Q000601:surgery; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*; D013525:Surgical Instruments; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: aneurysm; clip-wrap; far lateral approach; fusiform; posterior inferior cerebellar artery