Vertebral artery aneurysm- management


Posterior circulation aneurysms are being coiled all over the world. Some of aneurysms like at PICA origin or distal part of PICA, superior cerebellar artery , can be easily clipped as well. For reasons which I do not understand fully, coiling continues to be a costly affair and not all patients can afford to get  aneurysms coiled. Coiling has attracted commercial interest therefore many private sector hospitals have good DSA machines and specialists for coiling. Public hospitals have not moved much ahead and still many medical colleges are without neurosurgeons although they have CT scans and MRIs.

There is no public hospital which deals exclusively in cerebrovascular disease in India. Despite having lot of experienced doctors in public hospital ,they are not involved in future planning.  By 2017 Safdarjang Hospital will have a separate superspeciality block and God permitting I shall try my best to have a state of art Neurosurgery  deptt in that.

An adult male presented with subarachnoid haemorrhage and Angio revealed  a right vertebral artery aneurysm. Since patient was in bad clinical condition I waited for about 10 days so that he is in relatively better clinical condition. Since patient's family could not afford coiling I offered clipping which the family  agreed to.

A right retromastoid craniotomy was done in lateral position. The posterior lip of foramen magnum was removed on right side and dura opened parallel to sigmoid sinus. As soon as clip was applied aneurysm ruptured but it was finally clipped very well after placing a proximal and distal temporary clip on right vertebral artery.

Since I have plenty of experience in clipping of aneurysms I do not find it difficult to clip vertebral, PICA and Superior cerebellar artery aneurysms.

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