The case of a 65-year-old man with a ruptured VA-PICA aneurysm located at the midline is reported in this paper. He was admitted complaining of severe headache.
CT scan demonstrated massive subarachnoid hemorrhage, especially around the brain stem. Vertebral angiography showed a right VA-PICA aneurysm, located 4mm to the left from the midline and at lower 1/3 of clivus in height. The dome of the aneurysm projected to the right anteriorly. The aneurysm was approached with a combined subtemporal-transtentorial and lateral suboccipital approach.
The parent artery was reserved through a lateral suboccipital approach and the neck was clipped through a subtemporal transtentorial approach between the petrosal vein and the 7th, 8th nerve.
The combined subtemporal transtentorial and lateral suboccipital approach was advantageous in treating this VA-PICA aneurysm located at the midline and lower 1/3 clivus.
