Abstract
The operative approach to a lower basilar trunk aneurysm located in so-called“no man's land”is difficult. A case of large AICA aneurysm with AVM treated by radical surgery by the suboccipital approach is reported.
The patient was a 41-year-old woman. She experienced an attack of headache, nausea, vomiting and vertigo nine days before admission. She had no other complaints upon admission, and an enhanced computed tomography (CT) scan demonstrated high-density areas in the right cerebellar hemisphere and cerebellopontine angle. A large aneurysm at the lower basilar artery and AVM at the right cerebellar hemisphere were visualized on the vertebral angiogram. The feeders were the AICA, SCA and PICA, and the drainers were the inferior vermian vein and petrosal vein. The aneurysm was located between the AICA, which was the main feeder, and the basilar artery. The aneurysm was approached subtemporal-trans-tentorially. However, the aneurysmal neck could not be dissected. But the neck was clipped by the suboccipital approach. The aneurysm and AICA were not visualized on the postoperative vertebral angiogram. However, surgical complaints noted were abducent, facial and acoustic nerve palsy.
The subtemporal transtentorial approach with the combined use of the suboccipital approach had an advantage in treating this large aneurysm located at the lower basilar artery.
