A 21-year-old male presented to an outside hospital with subarachnoid hemorrhage due to a basilar artery-AICA aneurysm to an outside hospital. A left suboccipital craniotomy and far lateral transcondylar exposure was performed. The VI cranial nerve was adherent to a fragile daughter sac at the base of the aneurysm. Dissection of the neck resulted in aneurysm rupture from the daughter sac. In the process of trying to navigate a clip into the bloody field the gentle traction applied to the aneurysm neck essentially avulsed the aneurysm. This resulted in profuse bleeding that was not controllable with 2 or even 3 suctions. A temporary clip was therefore applied to the left vertebral artery through a very bloody field. This slowed down the bleeding but not sufficiently enough to allow safe clipping.
This information has been taken from Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single Center Retrospective Review. It was submitted by corresponding author Bernard R. Bendok, MD, of the Northwestern University Department of Neurological Surgery in Chicago, Illinois.