Clipping for Vertebral Artery-Posterior Inferior Cerebellar Artery Aneurysms: A Technical Note

Abstract

A vertebral-posterior inferior cerebellar artery (VA-PICA) aneurysm is rare. Although endovascular treatment might be chosen for many patients with VA-PICA aneurysms, neck clipping is still an important and significant treatment for VA-PICA aneurysms because coil embolization carries the risk of PICA occlusion. During craniotomy, the perforator may cause injuries to the dura mater and brain tissues because of the unparallel inner and outer cortices of the occipital bone near the sigmoid sinus. Care should be taken not to damage the large mastoid emissary vein. A large quantity of bone wax for the hemostasis of the mastoid emissary vein may cause sigmoid sinus occlusion. The vertebral and basilar arteries are basically located behind the lower cranial nerves. During the dissection of aneurysms, damage to these nerves should be avoided. Ring clips are also useful in preserving these nerves.