Abstract
Superior cerebellar artery (SCA) aneurysms are rare. The management options are not
well defined. There is increasing role of endovascular treatment for all aneurysms,
especially for aneurysms of the posterior circulation. However in some situations
(wide base, dysmorphic features) coiling is not feasible. The surgical management
of these aneurysms has its own distinct complexity and requires careful planning.
The classic pterional or subtemporal approaches had its own limitation in proper visualization
of the neurovascular anatomy.
In this video, we describe the technical nuances of transcavernous sinus approach
for microsurgical clipping SCA and A-comm aneurysms. We present the case of a 67-year-old
RHF who presented with ruptured right-sided SCA aneurysm. She complained of Headache,
confusion, and double vision. On physical examination, she had no focal deficits and
was Hunt and Hess grade 3. A brain computed tomography (CT) scan revealed a subarachnoid
hemorrhage Fisher's grade 4. A brain CT angiography (CTA) demonstrated an aneurysm
at the origin of right SCA. The patient had failed attempt of endovascular coiling
and she underwent microsurgical clipping.
Stepwise demonstration of the approach with cadaveric anatomical dissection is illustrated.
The technique presented here allows for safe clipping of the aneurysm through the
cavernous sinus. The approach allows for good exposure of the aneurysm and the surrounding
structures. Care is taken to visualize the perforators to avoid any devastating brain
stem infarction during the clipping.
The transcavernous sinus is a robust approach with good visualization of the neurovascular
structures allowing safe aneurysm clipping in this location.
The link to the video can be found at: https://youtu.be/oE-HyDASiKM.
Keywords
right superior cerebellar artery aneurysm - microsurgical clipping - cavernous sinus
- trans cavernous sinus approach
