Transjugular tubercle-preaccessory approach for ventrocaudally located PICA aneurysm.

BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysms are often located in the ventral craniocervical junction. Such deep-seated aneurysms are usually treated with coil embolization. However, recurred and/or very small PICA aneurysms are hardly treated with an endovascular approach.

METHOD: We present a modification of the transcondylar fossa approach with intradural and extradural removal of the jugular tubercle. An adequate preaccessory surgical corridor was created with this novel technique.

CONCLUSION: The ventocaudal PICA aneurysm was clipped through the outside of the spinal accessory nerve without surgical manipulation of other lower cranial nerves. This approach is worthwhile to avoid dysphagia.