Transjugular tubercle-preaccessory approach for ventrocaudally located PICA aneurysm

Posterior inferior cerebellar artery (PICA) aneurysms are often located in the ventral craniocervical junction. Such deep-seated aneurysms are usually treated with coil embolization. However, recurred and/or very small PICA aneurysms are hardly treated with an endovascular approach.

We present a modification of the transcondylar fossa approach with intradural and extradural removal of the jugular tubercle. An adequate preaccessory surgical corridor was created with this novel technique.

The ventocaudal PICA aneurysm was clipped through the outside of the spinal accessory nerve without surgical manipulation of other lower cranial nerves. This approach is worthwhile to avoid dysphagia.