title: Transjugular tubercle-preaccessory approach for ventrocaudally located PICA aneurysm.
abstract: Posterior inferior cerebellar artery (PICA) aneurysms are often located in the ventral craniocervical junction. Such deep-seated aneurysms are usually treated with coil embolization. However, recurred and/or very small PICA aneurysms are hardly treated with an endovascular approach.
  
  
  
  We present a modification of the transcondylar fossa approach with intradural and extradural removal of the jugular tubercle. An adequate preaccessory surgical corridor was created with this novel technique.
  
  
  
  The ventocaudal PICA aneurysm was clipped through the outside of the spinal accessory nerve without surgical manipulation of other lower cranial nerves. This approach is worthwhile to avoid dysphagia.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Japan. tetuyosi@shinshu-u.ac.jp.
authors.forename: Tetsuyoshi
authors.initials: T
authors.lastname: Horiuchi
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Japan.|Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr city, Cairo, Egypt.
authors.forename: Alhusain
authors.initials: A
authors.lastname: Nagm
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D001158:Arteries / Q000601:surgery; D002531:Cerebellum / Q000098:blood supply* / Q000601:surgery; D003391:Cranial Nerves / Q000601:surgery; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D013525:Surgical Instruments / Q000009:adverse effects
keywords: Aneurysm; Craniocervical junction; Jugular tubercle; Posterior inferior cerebellar artery; Surgery