[Macroglossia after neck clipping of a VA-PICA (vertebral artery-posterior inferior cerebellar artery) aneurysm].

A case of macroglossia following neck clipping of VA-PICA aneurysm is described. The etiology of this rare complication has been thought to be venous obstruction related to extreme flexion of the head in the sitting position. On the other hand, Moore et al recently proposed that the primary mechanism of macroglossia after posterior fossa exploration might be neurogenic origin. We consider that our case supports the latter hypothesis. In our case, the lingual swelling was aggravated for four consecutive days following the operation and then began to improve rapidly. The swelling resolved completely after 4 weeks. Glyceol and methylprednisolone sodium succinate were administered in an attempt to decrease the lingual swelling. But these drugs did not effectively minimize the swelling. It seemed that the lingual swelling resolved spontaneously. If macroglossia following posterior fossa exploration can be caused by abnormal autonomic nervous system discharges, stellate ganglion block, glossopharyngeal nerve block or vagus nerve block is thought to be indicated as treatment for the lingual swelling.