Transclival clipping for giant vertebral artery aneurysm: A case report

Abstract

Background: Endovascular treatment often achieves complete obliteration of VA giant aneurysm; however, retreatment may be required because of late recanalization. We report a case of giant VA aneurysm that showed regrowth after endovascular treatment and was treated with VA clipping using the endoscopic endonasal transclival approach. Case description: A 47-year-old man with chief complaint of ataxia underwent endovascular treatment of giant VA aneurysm. One year later, he needed additional treatment to regrowth of the aneurysm. We were not able to accomplish aneurysmectomy via the transcondylar fossa approach because of difficulty in achieving hemostasis and ended with partial thrombectomy. Digital subtraction angiography (DSA) performed after 4 months revealed coil compaction and distal flow due to recanalization. Right VA elongation and position of anterior spinal artery (ASA), these factors made possible for us to perform transclival approach to VA. Despite the limited indications for its use, endonasal endoscopic transclival clipping may be effective in limited anatomical cases. Conclusion: We report the use of endonasal endoscopic transclival clipping for giant VA aneurysm. This endonasal endoscopic treatment may be an optional alternative in only limited cases depending upon the anatomical location of the lesion because of limitations of vascular control and the inability to visualize the field in the presence of major bleeding. For treatment of progressive giant VA aneurysm, it is very important to avoid optimistic strategy for giant VA aneurysm initially. Keywords: Transclival clipping, Giant vertebral artery aneurysm, Vasa vasorum, Cerebrospinal fluid leakage, Flow diverter stent