Basilar Superior Cerebellar Artery Aneurysm Treated with Clipping via a Contralateral Pterional Approach

Abstract

We herein report a case of a basilar superior cerebellar artery (BA-SCA) aneurysm treated with clipping via a contralateral pterional approach. A woman in her 60s with multiple aneurysms was admitted to our hospital. Three-dimensional computed tomography angiography (3DCTA) showed aneurysms of the bilateral middle cerebral artery (MCA), anterior communicating artery (A-com), left BA-SCA, and left distal posterior cerebral artery. The right MCA aneurysm and A-com aneurysm were greater than 5 mm in size, and neck clipping via a right pterional approach was scheduled. In this operation, the possibility of neck clipping of the contralateral left BA-SCA aneurysm was preoperatively investigated. The aneurysm was 3 mm in size, and the height of the aneurysm from the top of the posterior clinoid process was 8 mm. We employed an optico-carotid triangle as an access route to the aneurysm, because the right internal carotid artery was curved posterolaterally, creating a wide surgical working space in the triangle. In addition to these findings, we paid attention to the rotation of the BA apex and the ideal closure line of the aneurysmal neck. The BA apex rotated 18° to the right side. The ideal closure line was straight and rotated 13° to the right side. These findings were thought to contribute to the visibility of the contralateral left BA-SCA aneurysm. The left BA-SCA aneurysm was clipped successfully via a contralateral pterional approach.