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J Cerebrovasc Endovasc Neurosurg. 2016 Jun;18(2):115-119. English. Case Report. https://doi.org/10.7461/jcen.2016.18.2.115
Lee W , Choo YS , Kim YB , Chung J .
Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. ns.joonho.chung@gmail.com
Department of Neurosurgery, Dongsan Medical Center, College of Medicine, Keimyung University, Daegu, Korea.
Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.
Abstract

We experienced a case of neurological deterioration after decompressive suboccipital craniectomy (DSC) in a patient with a brainstem-compressing thrombosed giant aneurysm of the vertebral artery (VA). A 60-year-old male harboring a thrombosed giant aneurysm (about 4 cm) of the right vertebral artery presented with quadriparesis. We treated the aneurysm by endovascular coil trapping of the right VA and expected the aneurysm to shrink slowly. After 7 days, however, he suffered aggravated symptoms as his aneurysm increased in size due to internal thrombosis. The medulla compression was aggravated, and so we performed DSC with C1 laminectomy. After the third post-operative day, unfortunately, his neurologic symptoms were more aggravated than in the pre-DSC state. Despite of conservative treatment, neurological symptoms did not improve, and microsurgical aneurysmectomy was performed for the medulla decompression. Unfortunately, the post-operative recovery was not as good as anticipated. DSC should not be used to release the brainstem when treating a brainstem-compressing thrombosed giant aneurysm of the VA.

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