This report deals with a rare case of fusiform aneurysm of the right vertebral artery associated with left glossopharyngeal neuralgia. A 61-year-old female was hospitalized for severe left pharyngeal pain. Vertebral angiography demonstrated a fusiform aneurysm of the right vertebral artery, which was displaced to the opposite side. On operating, the left posterior inferior cerebellar artery was found to be compressing the left 9th and 10th nerves. Neurovascular compression was associated with a fusiform aneurysm of the right tortuous vertebral artery. The fusiform aneurysm, which looked like a yellowish white, was clipped and microvascular decompression for the left 9th and 10th nerves was accomplished by the left advanced lateral suboccipital approach. Left glossopharyngeal neuralgia disappeared immediately after the operation.
Angiographically, differentiating diagnosis between an atherosclerotic fusiform aneurysm and a dissecting aneurysm is difficult. A fusiform aneurysm suggests not only an atherosclerotic fusiform aneurysm but also a dissecting aneurysm.
An advanced lateral suboccipital approach obtains sufficient operative field without complications. Therefore, the operation for an aneurysm of the vertebral artery should be performed with the advanced lateral suboccipital approach.
