МИКРОХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ДИСТАЛЬНОЙ АНЕВРИЗМЫ ЗАДНЕЙ НИЖНЕЙ МОЗЖЕЧКОВОЙ АРТЕРИИ В ХОЛОДНОМ ПЕРИОДЕ КРОВОИЗЛИЯНИЯ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Abstract

Aneurysms located on the distal portion of the posterior inferior cerebellar artery (PICA) are a rare disease that requires special treatment. Keeping the artery patent while excluding the aneurysm from the blood flow is essential during surgery. The patency ensures adequate blood circulation in the surrounding tissues and reduces the risk of ischemic complications. Therefore, carefully manipulating nearby anatomical structures is crucial to ensure successful surgery, minimize complications, and achieve optimal treatment results. This article describes a case of successful surgical intervention in a patient with a complex distal PICA aneurysm. The surgery was performed in the area of the anterior medullary segment using an extended retrosigmoid retrocondylar approach combined with C1 hemilaminectomy and monitoring the V3 segment of the vertebral artery. This approach has proven safe and effective, representing a promising alternative for the microsurgical treatment of PICA aneurysms, both in the acute and subacute stages of hemorrhage. The chosen surgical tactics helped prevent recurrent subarachnoid and intraventricular bleeding, as well as minimize the risk of ischemia, edema, and compression of the brain stem. These complications could lead to severe disability or even death. Keywords: Posterior inferior cerebellar artery, distal aneurysm, intraventricular hemorrhage, microsurgical treatment, aneurysm clipping, clinical case.