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Aljuboori Z, Hoz SS, Al-Sharshahi ZF, Ding D, Andaluz N. Surgical Clipping of a Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm: A Technical Note. Cureus 2021; 13:e18688. [PMID: 34790452 PMCID: PMC8584282 DOI: 10.7759/cureus.18688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/23/2022] Open
Abstract
Aneurysms of the distal anterior inferior cerebellar artery (AICA) are uncommon. They can present with subarachnoid hemorrhage (SAH), cerebellopontine angle syndrome, or a combination of the two. We describe the technique and nuances of microsurgical clipping of a ruptured distal AICA aneurysm using a retrosigmoid approach. After performing the craniotomy, the AICA was exposed in a distal to proximal fashion and the aneurysm and the proximal parent vessel were identified. After establishing proximal control, a clip was placed across the neck of the aneurysm to obliterate it while maintaining flow within the parent vessel. Finally, the flow within the parent vessel was confirmed and the final clip position was checked to ensure that it was not compressing any of the cranial nerves in the vicinity. The aneurysm was completely obliterated, and the parent vessel remained patent. Distal AICA aneurysms are rare and challenging to treat. The retrosigmoid approach is commonly used to treat these aneurysms. Careful planning, which includes studying the vascular anatomy and the aneurysm characteristics, and proficient execution of the procedure can increase the safety and improve outcomes of surgical clipping of these aneurysms.
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Affiliation(s)
- Zaid Aljuboori
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Samer S Hoz
- Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, IRQ
| | | | - Dale Ding
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Norberto Andaluz
- Neurosurgery, University of Cincinnati Medical Center, Cincinnati, USA
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Revascularization of the Anterior Inferior Cerebellar Artery Using Extracranial and Intracranial Donors: A Morphometric Cadaveric Study. World Neurosurg 2019; 127:e768-e778. [DOI: 10.1016/j.wneu.2019.03.260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 11/20/2022]
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Rasmussen J, Plou P, Campero Á, Ajler P. A Classification for the Anterior Inferior Cerebellar Artery-Subarcuate Artery Complex Based on the Embryological Development. J Neurol Surg B Skull Base 2019; 81:536-545. [PMID: 33134020 DOI: 10.1055/s-0039-1692474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
Abstract
Objective To hierarchize the anterior inferior cerebellar artery (AICA)-subarcuate artery (SAA) complex's variations in the surgical field. Background The AICA's "subarcuate loop" (SL) presents multiple variations, closely related to the SAA. AICA-SAA complex's variations may represent major issues in cerebellopontine angle (CPA) surgery. As the spectrum of configurations is originated during the development, a systematized classification was proposed based on the interaction between the petrosal bone and the AICA in the embryonic period. Methods The variations were defined as follow: Grade 0: free, purely cisternal AICA, unidentifiable or absent SAA; Grade 1: purely cisternal AICA, loose SL, SAA > 3 mm; Grade 2: AICA near the subarcuate fossa, pronounced SL, SAA <3 mm; Grade 3: "duralized" AICA, unidentifiable SAA, or included in the petromastoid canal (PMC); and Grade 4: intraosseous AICA, unidentifiable SAA, or included in the PMC. The classification was applied to a series of patients assessed by magnetic resonance constructive interference in steady state sequence. Surgical examples were also provided. Results Eighty-four patients were evaluated, including 161 CPA. The proportions found in the gradation remained within the range of previous publications (Grade 0: 42.2%; Grade 1: 11.2%; Grade 2: 35.4%; Grade 3: 10.6%; and Grade 4: 0.6%). Moreover, the degrees of the classification were related to the complexity of the anatomical relationships and, therefore, to the difficulty of the maneuvers required to overcome them. Conclusion The proposed AICA-SAA complex classification allowed to distinguish and objectify pre- and intraoperatively the spectrum of variations, to thoroughly plan the required actions and instrumentation.
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Affiliation(s)
- Jorge Rasmussen
- Department of Neurosurgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pedro Plou
- Department of Neurosurgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Álvaro Campero
- Department of Neurosurgery, Padilla Hospital, Tucumán, Argentina
| | - Pablo Ajler
- Department of Neurosurgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Sosa P, Dujovny M, Onyekachi I, Sockwell N, Cremaschi F, Savastano LE. Microvascular anatomy of the cerebellar parafloccular perforating space. J Neurosurg 2016; 124:440-9. [DOI: 10.3171/2015.2.jns142693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle—namely, the paraflocculus or parafloccular perforating space—has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle.
METHODS
Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized.
RESULTS
A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported.
CONCLUSIONS
The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the cerebellopontine angle.
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Affiliation(s)
- Pablo Sosa
- 1Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Mendoza, Argentina
| | - Manuel Dujovny
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Ibe Onyekachi
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Noressia Sockwell
- 2Departments of Neurosurgery and Electrical Engineering, Wayne State University, Detroit; and
| | - Fabián Cremaschi
- 1Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Mendoza, Argentina
| | - Luis E. Savastano
- 3Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Mahmoud M, El Serwi A, Alaa Habib M, Abou Gamrah S. Endovascular treatment of AICA flow dependent aneurysms. A report of three cases and review of the literature. Interv Neuroradiol 2012; 18:449-57. [PMID: 23217640 PMCID: PMC3520559 DOI: 10.1177/159101991201800411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 04/07/2012] [Indexed: 11/16/2022] Open
Abstract
Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare, accounting for less than 1% of all cerebral aneurysms. To our knowledge 34 flow-related cases including the present study have been reported in the literature. Three patients harbouring four flow dependent aneurysms were referred to our institution. Two patients presented with subarachnoid hemorrhage, one presented with cerebellar manifestations. They were all treated by endovascular embolization of the aneurysm as well as the parent artery using liquid embolic material. Two cases were embolized using NBCA, Onyx was used in the third case. No bleeding or rebleeding were encountered during the follow-up period which ranged from five to nine months. One patient developed facial palsy, cerebellar symptoms and sensorineural hearing loss. The remaining two cases did not develop any post treatment neurological complications. Endovascular management of flow-dependent AICA aneurysms by parent artery occlusion is feasible and efficient in terms of rebleeding prevention. Post embolization neurological complications are unpredictable. This depends upon the adequacy of collaterals from other cerebellar arteries.
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Affiliation(s)
- M Mahmoud
- Radiology Department, Ain Shams University, Cairo, Egypt.
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Ruptured intrameatal aneurysm of the anterior inferior cerebellar artery accompanying an arteriovenous malformation: a case report. THE CEREBELLUM 2012; 11:808-12. [PMID: 22218975 DOI: 10.1007/s12311-011-0349-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The distal anterior inferior cerebellar artery (AICA) aneurysms located inside the internal auditory canal are rare. The association of the distal AICA aneurysms and an arteriovenous malformation (AVM) on the same arterial trunk is exceptional. Eight reports of a total of ten cases have been published and all of the reported aneurysms were located in the meatal or postmeatal segment of the AICA. Herein, we report a case of ruptured aneurysm in the intrameatal portion of the AICA accompanying an AVM fed by the same artery. A 55-year-old man suffering from subarachnoid hemorrhage due to a ruptured intrameatal aneurysm with a small AVM underwent surgical trapping of the meatal loop, resulting in uneventful recovery. Follow-up angiography demonstrated neither aneurysm nor residual AVM nidus. We propose that trapping of the meatal loop could be a safe and feasible alternative to unroofing followed by neck clipping in selected patients with an intrameatal aneurysm of the AICA. We also review here the relevant literature.
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Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature. Neurosurg Rev 2011; 35:111-9; discussion 119. [PMID: 21748288 DOI: 10.1007/s10143-011-0338-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 05/05/2011] [Accepted: 05/15/2011] [Indexed: 10/18/2022]
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Lim SM, Cho YJ, Lee R. Multiple Feeding Artery Pedicle Pseudoaneurysms in the Posterior Circulation: Association with Hemorrhage and AVM. Neurointervention 2011; 6:27-30. [PMID: 22125745 PMCID: PMC3214807 DOI: 10.5469/neuroint.2011.6.1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 05/02/2010] [Indexed: 11/24/2022] Open
Affiliation(s)
- Soo Mee Lim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Yong Jae Cho
- Department of Neurosurgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Rena Lee
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Seoul, Korea
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Lee SH, Koh JS, Bang JS, Kim GK. A case of ruptured peripheral aneurysm of the anterior inferior cerebellar artery associated with an arteriovenous malformation : a less invasive image-guided transcortical approach. J Korean Neurosurg Soc 2009; 46:577-80. [PMID: 20062576 DOI: 10.3340/jkns.2009.46.6.577] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 04/12/2009] [Accepted: 10/26/2009] [Indexed: 11/27/2022] Open
Abstract
A 47-year-old man presented with a subarachnoid hemorrhage (SAH) and right cerebellar hematoma was referred for evaluation. Cerebral angiography revealed a distal anterior inferior cerebellar artery (AICA) aneurysm associated with an arteriovenous malformation (AVM). Successful obliteration and complete removal of the aneurysm and AVM were obtained using transcortical approach under the guidance of neuronavigation system. The association of a peripheral AICA aneurysm and a cerebellar AVM by the same artery is unique. The reported cases of conventional surgery for this disease complex are not common and their results are variable. Less invasive surgery using image-guided neuronavigation system would be helpful and feasible for a peripheral aneurysm combining an AVM of the posterior fossa in selective cases.
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Affiliation(s)
- Seung Hwan Lee
- Department of Neurosurgery, Stroke and Neurological Disorders Centre, East-West Neo Medical Hospital, KyungHee University School of Medicine, Seoul, Korea
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Bambakidis NC, Manjila S, Dashti S, Tarr R, Megerian CA. Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature. Neurosurg Focus 2009; 26:E6. [PMID: 19409007 DOI: 10.3171/2009.1.focus0915] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysms of the anterior inferior cerebellar artery (AICA) are relatively rare among intracranial aneurysms. They can occur in 1 of 3 regions of the AICA: 1) craniocaudal (high or low riding), 2) mediolateral-premeatal (proximal), and 3) meatal-postmeatal (distal). The management strategies for treatment differ according to the location and configuration of the aneurysm. The existing body of neurosurgical literature contains articles published on aneurysms arising from the AICA near the basilar artery (BA), intracanalicular/meatal aneurysms, and distal AICA. Several therapeutic options exist, encompassing microsurgical and endovascular techniques. The authors describe a case of treatment involving a large BA-AICA aneurysm approached via exposure of the presigmoid dura using a retromastoid suboccipital craniectomy and partial petrosectomy. Treatment of these lesions requires detailed knowledge of the anatomy, and an anatomical overview of the AICA with its arterial loops and significant branches is presented, including a discussion of the internal auditory (labyrinthine) artery, recurrent perforating arteries, subarcuate artery, and cerebellosubarcuate artery. The authors discuss the various surgical approaches (retromastoid, far lateral, subtemporal, and transclival) with appropriate illustrations, citing the advantages and disadvantages in accessing these AICA lesions in relation to these approaches. The complications of these different surgical techniques and possible clinical effects of parent artery occlusion during AICA surgery are highlighted.
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Affiliation(s)
- Nicholas C Bambakidis
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
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Figueiredo EG, Paiva WS, Teixeira MJ. A distal AICA aneurysm. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:112-4. [DOI: 10.1590/s0004-282x2009000100027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Lv X, Li Y, Liu A, Zhang J, Wu Z. Parent artery occlusion for peripheral anterior inferior cerebellar artery aneurysm. A case report and review of the literature. Neuroradiol J 2008; 21:261-5. [PMID: 24256838 DOI: 10.1177/197140090802100219] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 01/07/2008] [Indexed: 02/05/2023] Open
Abstract
Most cases of aneurysms associated with the distal portion of the anterior inferior cerebellar artery resulted in a hearing disturbance from the surgical procedure, although aneurysms far from the auditory artery had no deficit from trapping. We describe a patient with an aneurysm at the distal segment of the anterior inferior cerebellar artery (AICA) treated endovascularly by parent artery occlusion.
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Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute; Beijing, China - Beijing Tiantan Hospital, Capital Medical University; Beijing, China -
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Wong GKC, Zhu XL, Ng HK, Yu SCH, Poon WS. Vermal hemorrhage with fourth ventricle extension due to ruptured posterior inferior cerebellar artery aneurysm. J Clin Neurosci 2007; 15:203-5. [PMID: 17981039 DOI: 10.1016/j.jocn.2006.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 05/11/2006] [Accepted: 05/16/2006] [Indexed: 11/17/2022]
Abstract
Distal posterior inferior cerebellar artery (PICA) aneurysm located at the choroidal branch is uncommon. We report a ruptured distal PICA aneurysm in a 50-year-old man who presented with sudden onset of coma. The management and clinical significance are highlighted.
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Affiliation(s)
- George K C Wong
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Chinese University of Hong Kong, China
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