Microsurgical treatment of ruptured fusiform posterior inferior cerebellar artery aneurysm: case report

Abstract

Objective – according to the separate clinical observation to evaluate the strategy and tactics of an individualized treatment planning after the rupture of posterior inferior cerebellar artery (PICA) aneurysm in acute period of hemorrhagic stroke. Materials and methods. A retrospective analysis of the case of microsurgical treatment of PICA aneurysm in the acute period after hemorrhage was performed. The patient’s diagnosis and treatment was held at the State Institution «Romodanov Neurosurgery Institute, NAMS of Ukraine» in 2019. The patients age at the time of diagnosis was 50 years. The complex of diagnostic workout included clinical neurological examination, instrumental (neuroimaging and functional tests) and laboratory investigation. Results. According to the results of comprehensive clinical and instrumental examination, patient underwent emergency combined one-stage surgical procedure that include aneurysms clipping with external ventriculostomy of the posterior horn of the right lateral ventricle for surgical correction of the consequences after aneurysms rupture (expansion of the blood into the ventricular system, with hemotamponade of III and IV ventricle, internal obstructive hydrocephalus), which caused the emergency of surgical procedure. The intervention (external drainage of the posterior horn of the right lateral ventricle, clipping of left PICA aneurysm) was performed on the 5th day after rapture. Operation and postoperative period have passed without complications with positive neurological and neuroimaging follow-up. Conclusions. The applied diagnostic and therapeutic options can be utilized as a method of choice for individualized surgical planning after rapture of PICA aneurysm.