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Updated: Aug 25, 2025
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Endovascular assisted vertebrobasilar junction aneurysm clipping in a hybrid operation room. Case report
Àlex De Vilalta1, Pablo López1, Jose L Sanmillán1
1Department of Neurosurgery, Hospital Universitari de Bellvitge, Carrer Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
Introduction:
We present a case of a 60-year-old female that underwent surgery for clipping a right vertebrobasilar junction aneurysm (VBJA) in a hybrid operation room.
Research Question:
Does the retrograde suction technique with a proximal balloon is safe and effective as an adjuvant technique in surgery of VBJA?
Material And Methods:
After an extended retrosigmoid approach was performed, a 6F Neuron catheter with an intermediate multipurpose catheter were navigated to the right vertebral artery (VA) through a 6-French sheath, which caused a severe catheter-induced vasospasm in the right VA. The aneurysm was then deflated and clipped. After the withdrawal of the catheter the vasospasm was resolved.
Results:
The patient had a good recovery, with VI cranial nerve palsy and mild dysphagia due to mild right vocal cord palsy, both improving at 1-month follow-up and fully recovered at 6-month follow-up.
Discussion And Conclusion:
The combination of endovascular procedures and microsurgery at the same hybrid operation room in that case resulted in a safe and effective technique. It is an interesting tool that could help neurosurgeons deal with certain selected cases of VBJA. Intraoperative angiography offers the possibility to reposition a misplaced clip in the same surgery. Good collaboration between interventional neuroradiologists and vascular neurosurgeons helps in achieving good results in such difficult cases.
