Retrosigmoid Approach for Trapping and Removal of a Distal Dissecting Superior Cerebellar Artery Aneurysm in a Child

Javier Ros de San Pedro

doi:10.1055/s-0038-1675172

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 03): S335-S338
DOI: 10.1055/s-0038-1675172

Skull Base: Operative Videos

Georg Thieme Verlag KG Stuttgart · New York

Retrosigmoid Approach for Trapping and Removal of a Distal Dissecting Superior Cerebellar Artery Aneurysm in a Child

Javier Ros de San Pedro

¹Regional Service of Neurosurgery, Vascular Neurosurgery Unit, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar (Murcia), Spain

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Abstract

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Keywords

cerebellopontine angle - dissecting aneurysm - distal superior cerebellar artery - aneurysm trapping - retrosigmoid craniotomy

Fig. 1 Comparison between pre- and postoperative MRI. The upper left image corresponds to an axial T2WI slice, where the SCA aneurysm is displayed as a heterogenous, round lesion in the left CPA, which causes slight edema on the neighboring middle cerebellar peduncle. The lower left image is an axial postoperative T2WI, which shows the left CPA with no relapsing aneurysm. Note that the perilesional edema in the middle cerebellar peduncle has completely disappeared. The upper right image corresponds to an axial T1WI after intravenous contrast administration, which clearly depicts the dissecting SCA aneurysm along with the proximal and distal parent artery. The lower right image is an axial postoperative T1WI after contrast injection that demonstrates the absence of the aneurysm, whereas the patent SCA is distinctly shown. CPA, cerebellopontine angle; MRI, magnetic resonance imaging; Postop, postoperative; Preop, preoperative;SCA, superior cerebellar artery; WI, weighted image.

Fig. 2 Intraoperative images through a retrosigmoid craniotomy. (A) Distal dissecting SCA aneurysm in the left CPA. The aneurysm is tightly adhered to the cerebellum on its posterior and medial aspects, whereas its inferior pole leans on the VII, VIII nerves complex. (B) The aneurysm neck is completely shown, including the proximal and distal parent artery segments. Due to the neck shape this aneurysm was deemed unclippable, for which trapping and removal was chosen as the best surgical option. (C) Complete left CPA exposure after aneurysm removal. Note the presence of two aneurysm clips. The superior petrosal vein, trigeminal nerve, and the VII-VIII nerves complex are clearly shown. A stimulator probe is applied on the V nerve checking its function. (D) Final view of the left CPA after aneurysm removal. The same structures as in C are shown, plus the lower cranial nerves caudally to the facial-acoustic complex. CPA, cerebellopontine angle; SCA, superior cerebellar artery.

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Fig. 1 Comparison between pre- and postoperative MRI. The upper left image corresponds to an axial T2WI slice, where the SCA aneurysm is displayed as a heterogenous, round lesion in the left CPA, which causes slight edema on the neighboring middle cerebellar peduncle. The lower left image is an axial postoperative T2WI, which shows the left CPA with no relapsing aneurysm. Note that the perilesional edema in the middle cerebellar peduncle has completely disappeared. The upper right image corresponds to an axial T1WI after intravenous contrast administration, which clearly depicts the dissecting SCA aneurysm along with the proximal and distal parent artery. The lower right image is an axial postoperative T1WI after contrast injection that demonstrates the absence of the aneurysm, whereas the patent SCA is distinctly shown. CPA, cerebellopontine angle; MRI, magnetic resonance imaging; Postop, postoperative; Preop, preoperative;SCA, superior cerebellar artery; WI, weighted image.

Fig. 2 Intraoperative images through a retrosigmoid craniotomy. (A) Distal dissecting SCA aneurysm in the left CPA. The aneurysm is tightly adhered to the cerebellum on its posterior and medial aspects, whereas its inferior pole leans on the VII, VIII nerves complex. (B) The aneurysm neck is completely shown, including the proximal and distal parent artery segments. Due to the neck shape this aneurysm was deemed unclippable, for which trapping and removal was chosen as the best surgical option. (C) Complete left CPA exposure after aneurysm removal. Note the presence of two aneurysm clips. The superior petrosal vein, trigeminal nerve, and the VII-VIII nerves complex are clearly shown. A stimulator probe is applied on the V nerve checking its function. (D) Final view of the left CPA after aneurysm removal. The same structures as in C are shown, plus the lower cranial nerves caudally to the facial-acoustic complex. CPA, cerebellopontine angle; SCA, superior cerebellar artery.