Aberrant AICA Injury During Translabyrinthine Approach

Area of Science:

• Neurosurgery
• Vascular Anatomy
• Skull Base Surgery

Background:

• Vestibular schwannomas are tumors requiring surgical resection.
• The translabyrinthine approach is a common surgical method for posterior fossa tumors.
• Vascular anomalies can complicate skull base surgery.

Observation:

• A 59-year-old male with a vestibular schwannoma underwent a translabyrinthine approach.
• An aberrant anterior inferior cerebellar artery (AICA) loop was found within the petrous temporal bone during surgery.
• The patient developed transient facial paresis and unusual nystagmus post-operatively.

Findings:

• MRI confirmed an ischemic lesion in the AICA's vascular territory, affecting the cerebellum and cranial nerve VII.
• The aberrant AICA loop was identified as the likely cause of the ischemic insult.
• Despite neurological deficits, the patient achieved excellent functional recovery.

Implications:

• This case underscores the importance of recognizing rare AICA anatomical variations.
• Preoperative awareness of potential vascular anomalies is crucial for surgical planning.
• Postoperative neurological monitoring is essential for detecting and managing complications in skull base surgery.