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.
Keywords: AICA, Anterior Inferior Cerebellar Artery; Aneurysm clipping; CN, Cranial Nerves; DSA, Digital Subtraction Angiography; Endovascular assisted; Hybrid operation room; ICG, Indocianine Green Fluorescence; IONM, Intraoperative Neurophysiologic Monitoring; PICA, Posterior Inferior Cerebellar Artery; VA, Vertebral Artery; VBJA, Vertebrobasilar Junction Aneurysm; Vertebrobasilar junction aneurysm.
© 2022 The Authors.