抄録
Surgery for VA-PICA aneurysms located near the anterior midline of the brainstem is one of the most difficult kinds of surgery. We successfully clipped a right VA-PICA aneurysm located in the anterior midline of the medulla oblongata through the transcondylar approach. A 47-year-old female was admitted because of headache, nausea, vomiting and loss of consciousness. CT scan showed a subarachnoid hemorrhage. Vertebral angiography revealed a right VA-PICA aneurysm located in the anterior midline of the medulla oblongata and at almost the same level as the hypoglossal canal. Direct clipping was first tried through the transcondylar fossa approach, but the aneurysm could not be exposed because of the obstacle created by the 12th C. N. Then the approach was changed to the transcondylar approach and partial condylectomy and partial Cl hemi-laminectomy were added. The aneurysm was clearly exposed through the approach with retraction of the medulla oblongata. A clip was successfully applied through the space between the 12th C. N. and the vertebral artery. The postoperative course was uneventful, and the patients was discharged without any neurological deficits. We discuss surgical approaches to VA-PICA aneurysms located near the midline in consideration of the level of the aneurysm, which is superior or inferior to the hypoglossal canal and nerves. Then we clarify the difference between the applications of the transcondylar fossa approach and the transcondylar approach to such VA-PICA aneurysms.
