Subarachnoid Haemorrhage

Contributor:

Dr. Krishna Kumar

Consultants:

Dr. Mike Tymianski

Case 20

Age: 38

Sex: Female

History: Presented with acute onset of headache and neck pain on May 11, 2003. A CT scan confirmed SAH without localization. Pan-cerebral angiography on May 12, 2003 failed to show any aneurysm. Angiography was repeated on May 20th, which showed a 4mm aneurysm situated on the left PICA. A posterior fossa left lateral craniotomy was performed in park bench position, on May 22, 2003. However couldn't see the origin of PICA or the aneurysm. Intraoperative angiography was done with marker clips, it showed that the origin of PICA was close to the midline, inspite of repeated attempts we could not visualize the aneurysm without too much traction on the brain stem or lower cranial nerves. Therefore the procedure was aborted.

Question?

Can this aneurysm be embolized or clipped using a far lateral approach? Patient at present Grade I.

June 2003 - Dr. Mike Tymianski, Neurosurgeon - Toronto

Patient sent to Toronto. Dr. Tymianski performed a posterior fossa craniotomy on her from the opposite side and was able to clip the aneurysm. Patient has done very well. Post-op images will be posted later.

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