Abstract
We successfully clipped a right VA-PICA aneurysm through the transcondylar fossa approach. The usefulness of this approach is reported.
A 66-year old female was admitted because of moderate headache, nausea and vomiting. CT scan showed subarachnoid hemorrhage particularly in the cisterns of the right posterior fossa. Vertebral angiography revealed a right VA-PICA aneurysm located 5.3mm apart from the midline and 6mm inferior to the internal auditory meatus. Direct clipping was done through the transcondylar fossa approach. A straight clip was applied through the space between the vagus and hypoglossal nerves. Postoperative hypoglossal nerve palsy and hoarseness disappeared within a week. The postoperative angiography revealed complete obliteration of the aneurysm.
The transcondylar fossa approach differs from the transcondylar approach. In the transcondylar fossa approach, the condylar fossa and jugular tubercle are extradurally drilled. The occipital condyle is kept intact so that the atlanto-occipital joint movement is well preserved. This approach is very useful for VA or VA-PICA aneurysm, giving a wider operative field and closer access.
