Background and Introduction: Clipping an aneurysm on an elongated and tented V4 segment near the origin of the posterior inferior cerebellar artery (high-riding VA-PICA junction aneurysm) can be challenging.
Objective: We demonstrate the microsurgical clipping technique of such an aneurysm using a modified retromastoid approach (MRMA) and glossopharyngeal-cochlear triangle (GCT).
Surgical Technique: A 50-year-old female with a ruptured high-riding left VA-PICA junction aneurysm underwent an MRMA. Using segmental vessel isolation with proximal and distal temporary clips, this aneurysm was occluded through the GCT by applying a tandem clipping technique while preserving the PICA.
Results: The procedure was uneventful. Apart from transient ataxia, she recovered completely and maintains a good status at follow-up.
Conclusion: In high-riding VA-PICA junction aneurysms, a conventional far lateral approach may create awkward viewing and working angles. An MRMA with a horizontal trajectory through the GCT may be a more appropriate strategy.


中文翻译：

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“高位”VA-PICA 交界处动脉瘤的改良乳突后入路和夹闭：手术视频


背景和简介：在小脑后下动脉（高位 VA-PICA 交界处动脉瘤）起点附近的细长和帐篷 V4 段上夹闭动脉瘤可能具有挑战性。
目的：我们展示了使用改良乳突后入路 (MRMA) 和舌咽-耳蜗三角 (GCT) 对此类动脉瘤的显微外科夹闭技术。
手术技术：一名 50 岁女性，左侧 VA-PICA 交界处高位动脉瘤破裂，接受了 MRMA。使用具有近端和远端临时夹的分段血管隔离，通过应用串联夹闭技术通过 GCT 闭塞该动脉瘤，同时保留 PICA。
结果：过程很顺利。除一过性共济失调外，她已完全康复，并在随访中保持良好状态。
结论：在高位 VA-PICA 交界处动脉瘤中，传统的远侧入路可能会产生尴尬的观察角度和工作角度。具有通过 GCT 的水平轨迹的 MRMA 可能是更合适的策略。