Abstract
Symptomatic thrombosed vertebral artery aneurysms are challenging to treat due to their anatomical location, particularly concerning the brainstem and vital cranial nerves. We report a case in which “hybrid surgery” combining craniotomy and endovascular surgery was attempted.
The patient was a man in his 50s who presented to our hospital with stuttering and dizziness. Magnetic resonance imaging (MRI) revealed a thrombosed aneurysm with a maximum diameter of 34 mm in the right vertebral artery, which was compressing the brainstem.
The initial surgery was conducted in a hybrid operating room to occlude the right vertebral artery using both endovascular treatment and direct surgical intervention. Thrombectomy was performed in a second stage via direct surgery to decompress the brainstem area.
In thrombosed aneurysms, the vasa vasorum is a significant contributor to thrombus enlargement, making it challenging to treat with endovascular methods alone. Direct surgery plays a crucial role in interrupting the vasa vasorum.
In posterior cranial fossa surgery, where surgical manipulation is restricted, combined endovascular surgery offers a minimally invasive treatment option that can effectively occlude the parent vessel.
