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Bernard R. Bendok
Neurosurgery. 69(4):815-821, October 2011
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.
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