Intracranial Arterial Loop with a Complex Partially Thrombosed Large Aneurysm in the Posterior Circulation: A Case Report

Naeem Hamza*, Lana Majbour, Nuaman Ahmed and Naeema Zainaba

Abstract

Large, partially thrombosed intracranial aneurysms (PTIAs) in the posterior circulation are uncommon and technically challenging. Their presentation can overlap with posterior circulation stroke syndromes, particularly lateral medullary (Wallenberg) syndrome, complicating early diagnosis. Optimal treatment is individualized among microsurgical, endovascular, and hybrid strategies. A 66-year-old woman presented with headache, vertigo, visual impairment, and right peripheral facial palsy (House–Brackmann II). MRI/MRA and CTA demonstrated a posteriorcirculation aneurysm measuring 16.1 × 13.8 mm, wide neck >4 mm, partial intraluminal thrombosis, and an associated arterial loop displacing the lateral medulla. Following multidisciplinary deliberation, microsurgical treatment was chosen. The patient was positioned sitting with the head secured in a Mayfield clamp; a right suboccipital craniotomy was performed starting with two burr holes, using a retrosigmoid approach. The aneurysm was visualized deep in the cerebellomedullary cistern adjacent to cranial nerves IX–XII, and microsurgical clipping of the neck was performed. Post-operatively, facial palsy worsened to House–Brackmann III/IV, without new focal deficits. Follow-up imaging is pending at the time of writing.

Keywords

Partially Thrombosed Aneurysm, Posterior Circulation, Pica Region, Retrosigmoid, Lateral Medullary Syndrome, Microsurgical Clipping, Case Report

Corresponding Author

Naeem Hamza, Iuliu Hatieaganu Universoty Of Medicine and Phrmacy Cluj Napoca, Romania.

Citation

Hamza, N., Majbour, L., Ahmed, N., Zainaba, N. (2025). Intracranial Arterial Loop with a Complex Partially Thrombosed Large Aneurysm in the Posterior Circulation: A Case Report. Epidemiol Public Health OA , 1(1), 01-07.