Abstract
The treatment paradigm for intracranial aneurysms has evolved with technological advancements, resulting in improved patient outcomes. In particular, the management of posterior circulation aneurysms has shifted to favor endovascular therapy (EVT). However, this modality is not always accessible in low-resource settings.In our country (Trinidad and Tobago), neuroendovascular services are not readily available. We report a case of a patient with a ruptured left posterior inferior cerebellar artery (PICA) aneurysm (Fisher grade 4) who underwent a far-lateral craniotomy and clip ligation. It was done by a fellowship-trained vascular neurosurgeon in a public hospital and resulted in an excellent patient outcome. This highlights the need to maintain this surgical skill set in resource-poor countries, in spite of the increasing popularity of endovascular therapy.
Highlights
Treatment paradigms for intracranial aneurysms have changed with technological advancements, resulting in improved patient outcomes
We report a case of a patient with a ruptured posterior inferior cerebellar artery (PICA) aneurysm (Fisher grade 4) who underwent a far-lateral craniotomy and clip ligation with a good outcome
We opted for computed tomography (CT) angiography, which confirmed a 5 x 4 x 5 mm left posterior inferior cerebellar artery (PICA) aneurysm (Figure 1)
Summary
Treatment paradigms for intracranial aneurysms have changed with technological advancements, resulting in improved patient outcomes. We report a case of a patient with a ruptured posterior inferior cerebellar artery (PICA) aneurysm (Fisher grade 4) who underwent a far-lateral craniotomy and clip ligation with a good outcome. This highlights the need to maintain the ability to surgically clip aneurysms, especially in countries where endovascular therapy is not readily available. We opted for CT angiography, which confirmed a 5 x 4 x 5 mm left posterior inferior cerebellar artery (PICA) aneurysm (Figure 1). Aside from a high-speed drill, operative microscope and a limited selection of aneurysm clips (Sugita, cobalt alloy), no adjuncts commonly used in aneurysm surgery were available This included neuromonitoring, micro-Doppler, or indocyanine green. Placement of permanent clip on the neck of aneurysm (A, green arrow) and visual assessment of the patency of the posterior inferior cerebellar artery (B, green arrow)
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