Posterior circulation aneurysms

Question 1

MCC BA anurysum cause

Answer 1

Traumatic ➡️ dissecting aneurysms

Question 2

MCC VAA arise from

Answer 2

VA-PICA junction➡️ VA-AICA, ➡️ VA-BA.

Question 3

Allcock test use for

Answer 3

Asses patency for COW
VA injection with compression ICA

Question 4

TX for VAA

Answer 4

Clipping
Colling

fusiform, giant, or dissecting aneurysms)➡️ proximal VA ligation distal tonPICA or occlusion of VA distal to PICA , midcervical VA occlusion by Amplatzer plug

Question 5

VA- PICA origin anurysum MCC site

Answer 5

most commonly at the distal (superior) angle 📐 of PICA

anterolateral portion of the medullary cistern

Question 6

Should tx even if incidental

Answer 6

PICA aneurysms distal to the VA-PICA junction

Question 7

Vertebrobasilar junction aneurysms surgical approach

Answer 7

suboccipital approach

subtemporal-transtentorial approach➡️ if VB junction is high

Question 8

Basilar bifurcation aneurysms = basilar tip

Answer 8

MCC posterior circulation aneurysm

Question 9

height of the aneurysm of BA tip relative to posterior clinoid

Answer 9

supraclinoidal➡️ neck > 5 mm superior to posterior clinoid process

clinoidal ➡️ neck within 5 mm to posterior clinoid process

infraclinoidal➡️ neck 5 mm below 👇 posterior clinoid process

Question 10

Basilar tip aneurysms

Answer 10

All BA tip approach by pterional except posterior pointing ➡️ apprach by sub temporal

orbitozygomatic approach:➡️ access to portions of the basilar artery below the bifurcation.

Question 11

Basilar artery aneurysm from

Answer 11

Fusiform

Question 12

Basilar artery aneurysm rupture 🚨 intra
Op critical steps

Answer 12

dissection of Liliequist’s membrane exposes the interpeduncular cistern with proximal BA

Question 13

Early poor results with clipping of basilar tip aneurysms

Answer 13

sacrificing Thalamoperforating arteries➡️ lacunar infarcts