1
|
Muhammad S, Hafez A, Kaukovalta H, Rezai Jahromi B, Kivisaari R, Hänggi D, Niemelä M. Anterior inferior cerebellar artery (AICA) aneurysms: a radiological study of 15 consecutive patients. FRONTIERS IN RADIOLOGY 2023; 3:1229921. [PMID: 37614531 PMCID: PMC10442703 DOI: 10.3389/fradi.2023.1229921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023]
Abstract
Introduction The aneurysms of the anterior inferior cerebellar artery (AICA) are rare lesions of the posterior circulation and to treat them is challenging. We aim to present anatomical and morphological characteristics of AICA aneurysms in a series of 15 patients. Method The DSA and CT angiography images of AICA aneurysms in 15 consecutive patients were analyzed retrospectively. Different anatomical characteristics were quantified, including morphology, location, width, neck width, length, bottleneck factor, and aspect ratio. Results Eighty percent of the patients were females. The age was 52.4 ± 9.6 (mean ± SD) years. 11 patients were smokers. Ten patients had a saccular aneurysm and five patients had a fusiform aneurysm. Aneurysm in 10 patients were located in the proximal segment, in three patients in the meatal segment, and in two patients in the distal segment. Ten out of 15 patients presented with a ruptured aneurysm. The size of AICA aneurysms was 14.8 ± 18.9 mm (mean ± SD). The aspect ratio was 0.92 ± 0.47 (mean ± SD) and bottleneck factor was 1.66 ± 1.65 (mean ± SD). Conclusion AICA aneurysms are rare lesions of posterior circulation predominantly found in females, present predominantly with subarachnoid hemorrhage, and are mostly large in size.
Collapse
Affiliation(s)
- Sajjad Muhammad
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
| | - Ahmad Hafez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Kaukovalta
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
2
|
Muhammad S, Hafez A, Kaukovalta H, Jahromi BR, Kivisaari R, Hänggi D, Niemelä M. Treatment and Outcome of Anterior Inferior Cerebellar Artery (AICA) Aneurysms: Helsinki Series of 15 Consecutive Patients. Asian J Neurosurg 2023; 18:30-35. [PMID: 37056905 PMCID: PMC10089755 DOI: 10.1055/s-0042-1758844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Abstract
Objective Anterior inferior cerebellar artery (AICA) aneurysms are rare posterior circulation lesions that are challenging to treat. This article presents the treatment and clinical outcome of AICA aneurysms in an unselected cohort of patients.
Methods A retrospective analysis of patient record files, digital subtraction angiography, and computed tomography angiography images of 15 consecutive patients harboring AICA aneurysms treated between 1968 and 2017.
Results Of the 15 AICA aneurysm patients reviewed, 12 (80%) were females. Twenty percent had intracerebral hemorrhage and 40% presented with intraventricular hemorrhage. Eleven out of 15 (73%) patients presented with subarachnoid hemorrhage (SAH); 82% of SAH patients had a good-grade SAH (Hunt and Hess grade 1–3). Eleven patients (73%) were treated surgically, three (20%) were treated conservatively, and one (7%) had coil embolization. In 27% of patients, a subtemporal approach with anterior petrosectomy was performed. A retrosigmoid approach was used in the remaining 73%. In 18% of the patients, a parent vessel occlusion was necessary to occlude the aneurysm. Five out of 11 (47%) of the patients developed postoperative cranial nerve deficits. Twenty-seven percent developed shunt-dependent hydrocephalus. All patients who presented with an unruptured AICA aneurysm had good clinical outcome (modified Rankin scale [mRS] 1–2). In patients with SAH, 82% achieved good clinical outcome and 18% had poor clinical outcome (mRS 3–6) after 1 year.
Conclusion Surgical treatment of AICA aneurysms has a high rate of cranial nerve deficits but most of patients have a good long-term clinical outcome.
Collapse
Affiliation(s)
- Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hanna Kaukovalta
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| |
Collapse
|
3
|
Okada T, Makimoto K, Yoshii R, Yoshimoto K, Moinuddin FM, Yamashita M, Arita K. Dissecting aneurysm of the anterior inferior cerebellar artery in the internal auditory canal presenting with deafness without hemorrhage: A case report and literature review. Surg Neurol Int 2022; 13:88. [PMID: 35399907 PMCID: PMC8986759 DOI: 10.25259/sni_1220_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/15/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Anterior inferior cerebellar artery (AICA) aneurysms in the internal auditory canal (IAC) are rare. We have reported a case of dissecting AICA aneurysm in the IAC presenting initially with the eighth nerve palsy followed by the seventh nerve palsy without hemorrhage.
Case Description:
A 68-year-old woman presented with a sudden onset of vertigo accompanied by deafness and tinnitus on the right side that was preceded by intermittent right retroauricular pain 2 weeks before. Audiogram showed severe sensorineural hearing loss. Computed tomography and magnetic resonance imaging (MRI) indicated absence of prior subarachnoid hemorrhage. Magnetic resonance angiogram (MRA) suggested a tiny aneurysm at the fundus of the IAC accompanied with thinning of the lateral pontine segment of the AICA. Conservative treatment led to moderate improvement of the symptoms. However, the patient developed the right retroauricular pain again, followed by the right facial paralysis 5 months later but still without signs of hemorrhage on MRI. Digital subtraction angiogram showed dissecting aneurysm in the IAC. The patient was managed with oral steroids and direct intervention was avoided due to a risk of ischemia supposed by large area irrigated by the AICA. Follow-up MRA 18 months after the first presentation showed improvement in the narrowing of the AICA proximal to the aneurysm. The patient was functionally independent despite right-sided hearing loss and slight facial paresis.
Conclusion:
This report warns physicians that a dissecting AICA aneurysm without subarachnoid hemorrhage may cause eighth and seventh nerve palsy.
Collapse
Affiliation(s)
- Tomohisa Okada
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan,
| | - Kaisei Makimoto
- Department of Radiology, Izumi Regional Medical Center, Akune, Japan,
| | - Riichiro Yoshii
- Department of Orthopedics, Yoshii-chuo Hospital, Izumi, Japan,
| | - Koji Yoshimoto
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan,
| | - F. M. Moinuddin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States,
| | - Masaru Yamashita
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan,
| |
Collapse
|
4
|
Nussbaum ES, Goddard JK, Lowary J, Robinson JM, Hilton C, Nussbaum LA. Delayed sudden hearing recovery after treatment of a large vertebral artery aneurysm causing hearing loss and imbalance: a case report. Br J Neurosurg 2019; 36:515-519. [PMID: 31793349 DOI: 10.1080/02688697.2019.1698013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Cerebral aneurysms that compress cranial nerve VIII can cause hearing loss and imbalance. Hearing function that does not recover after aneurysm occlusion can signal neurological damage with the potential for permanent deafness.Case Description: A 72-year-old woman presented with gradually worsening left-sided hearing loss and imbalance over a period of 10 years. She was found to have a lesion of the cerebellopontine angle, which proved to be a large fusiform vertebral artery aneurysm with mass effect on cranial nerve VIII. The patient underwent surgical clip occlusion of the vertebral artery distal to the posterior inferior cerebellar artery and proximal to the aneurysm, which no longer filled on catheter angiography. Postoperatively, the patient experienced delayed complete loss of ipsilateral hearing on the third post-operative day. Otherwise, she made a good recovery with improvement in her balance issues. At that time, we suspected that delayed occlusion of a perforating vessel had probably caused irreversible hearing loss. Ten months later, the patient awoke with significant subjective recovery of her hearing. Audiometry confirmed substantial improvement in her hearing likely due to the aneurysm shrinking away from and decompressing the cranial nerve.Conclusion: This case highlights the continued usefulness of vascular occlusion in the management of selected cases of intracranial aneurysms and also that neurological function may recover suddenly, even in very delayed fashion, following treatment.
Collapse
Affiliation(s)
- Eric S Nussbaum
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, United Hospital, Twin Cities, MN, USA
| | | | - Jodi Lowary
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, United Hospital, Twin Cities, MN, USA
| | - Jenna M Robinson
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Chris Hilton
- Department of Otolaryngology, Regions Hospital, Saint Paul, MN, USA
| | - Leslie A Nussbaum
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, United Hospital, Twin Cities, MN, USA
| |
Collapse
|
5
|
Lee BS, Witek AM, Moore NZ, Bain MD. Treatment of an Anterior Inferior Cerebellar Artery Aneurysm With Microsurgical Trapping and In Situ Posterior Inferior Cerebellar Artery to Anterior Inferior Cerebellar Artery Bypass: Case Report. Oper Neurosurg (Hagerstown) 2017; 15:418-424. [DOI: 10.1093/ons/opx275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/23/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Anterior inferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment can involve microsurgical and/or endovascular techniques. Such treatment can be challenging and may carry a significant risk of neurological morbidity.
OBJECTIVE
To demonstrate a case involving a complex AICA aneurysm that was treated with a unique microsurgical approach involving trapping the aneurysm and performing in Situ bypass from the posterior inferior cerebellar artery (PICA) to the distal AICA. The nuances of AICA aneurysms and revascularization strategies are discussed.
METHODS
The aneurysm and the distal segments of AICA and PICA were exposed with a retrosigmoid and far lateral approach. A side-to-side anastomosis was performed between the adjacent caudal loops of PICA and AICA. The AICA aneurysm was then treated by trapping the aneurysm-bearing segment of the parent vessel between 2 clips.
RESULTS
A postoperative angiogram demonstrated a patent PICA-AICA bypass and complete occlusion of the AICA aneurysm. There were no complications, and the patient made an excellent recovery.
CONCLUSION
The combination of parent vessel sacrifice and bypass remains an excellent option for certain difficult-to-treat aneurysms. This case involving PICA-AICA bypass to treat an AICA aneurysm serves as an example of the neurosurgeon's ability to develop unique solutions that take advantage of individual anatomy.
Collapse
Affiliation(s)
- Bryan S Lee
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Alex M Witek
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Nina Z Moore
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Mark D Bain
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
6
|
Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. J Neurointerv Surg 2015; 8:e19. [PMID: 25964373 DOI: 10.1136/neurintsurg-2015-011736.rep] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/04/2022]
Abstract
Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA). We report a case of a 65-year-old man with a history of right-sided VS surgery and radiation who presented years later with a ruptured pseudoaneurysm of the distal right AICA and was treated with endovascular PVO using nBCA. The aneurysm was completely obliterated and the patient had no worsening of symptoms or neurological exam. The case illustrates a very rare complication of VS surgery and radiation as well as an effective treatment for distal AICA aneurysms.
Collapse
Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | | | - Joseph DeMattia
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| |
Collapse
|
7
|
Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. BMJ Case Rep 2015; 2015:bcr-2015-011736. [PMID: 25948851 DOI: 10.1136/bcr-2015-011736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA). We report a case of a 65-year-old man with a history of right-sided VS surgery and radiation who presented years later with a ruptured pseudoaneurysm of the distal right AICA and was treated with endovascular PVO using nBCA. The aneurysm was completely obliterated and the patient had no worsening of symptoms or neurological exam. The case illustrates a very rare complication of VS surgery and radiation as well as an effective treatment for distal AICA aneurysms.
Collapse
Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | | | - Joseph DeMattia
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| |
Collapse
|
8
|
Marchini AK, Mosimann PJ, Guichard JP, Boukobza M, Houdart E. Anterior inferior cerebellar artery aneurysms mimicking vestibular schwannomas. J Neuroimaging 2013; 24:404-6. [PMID: 23316934 DOI: 10.1111/j.1552-6569.2012.00752.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/11/2012] [Accepted: 06/22/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Unruptured anterior inferior cerebellar artery (AICA) aneurysms are rare but potentially lethal cerebellopontine angle (CPA) lesions that may be misdiagnosed as vestibular schwannomas when they present with vestibulo-cochlear symptoms. METHODS We report two cases of unruptured but symptomatic AICA aneurysms initially referred to us as atypical vestibular schwannomas requiring surgery. Two discriminant MR features are described. RESULTS One patient refused treatment. The other was successfully treated by coil occlusion. CONCLUSIONS Caution is advised before suspecting a CPA mass to be a purely extra-canalicular schwannoma, given its extreme rarity. Deafness and cerebellar ischemia may be prevented if AICA aneurysms are correctly identified preoperatively. In the absence of specific arterial imaging, two MR features may distinguish them from vestibular schwannomas: (1) the absence of internal auditory canal enlargement and (2) the "blurry dot sign," representing blood flow artefacts on pre- and postcontrast studies.
Collapse
|
9
|
FUJIMURA M, INOUE T, SHIMIZU H, TOMINAGA T. Occipital Artery-Anterior Inferior Cerebellar Artery Bypass With Microsurgical Trapping for Exclusively Intra-meatal Anterior Inferior Cerebellar Artery Aneurysm Manifesting as Subarachnoid Hemorrhage. Neurol Med Chir (Tokyo) 2012; 52:435-8. [DOI: 10.2176/nmc.52.435] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| |
Collapse
|
10
|
Nussbaum L, Defillo A, Zelensky A, Nussbaum ES. A short segment intracranial-intracranial jump graft bypass followed by proximal arterial occlusion for a distal MCA aneurysm. Surg Neurol Int 2011; 2:98. [PMID: 21811704 PMCID: PMC3144608 DOI: 10.4103/2152-7806.82991] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/20/2011] [Indexed: 11/24/2022] Open
Abstract
Background: To describe the use of a short segment cortical intracranial–intracranial (IC–IC) bypass for the treatment of a distal middle cerebral artery (MCA) aneurysm. Case Description: A 54-year-old woman presented with a loss of consciousness followed by multiple seizures and was found to have a partially thrombosed distal MCA aneurysm. This possibly mycotic aneurysm was treated by creating a short segment jump graft between a normal cortical artery and a nearby cortical branch arising from the aneurysmal M3 arterial segment. The bypass allowed for subsequent occlusion of the aneurysmal vessel without ischemic consequence. At surgery, the anterior division of the superficial temporal artery (STA) was exposed and dissected. Intraoperative angiography was utilized to localize a cortical artery arising from the involved segment as well as a nearby cortical artery arising from a distinct, uninvolved MCA branch. A segment of the STA was harvested, and then 10-0 suture was utilized to anastomose this short segment, to both the involved and normal cortical arteries. This created a short jump graft allowing for subsequent sacrifice of the diseased artery. Following surgery, the patient immediately underwent coil embolization of the aneurysm back into the parent artery resulting in local vascular sacrifice. The remainder of the patient's hospital course was uneventful. She was discharged home in good condition. Conclusions: We suggest that cortical IC–IC bypass followed by endovascular arterial sacrifice as performed in our case represents a simple and safe option for treating unclippable distal MCA aneurysms including mycotic lesions.
Collapse
Affiliation(s)
- Leslie Nussbaum
- Department of Neurosurgery, National Brain Aneurysm Center, St. Joseph's Hospital, St. Paul, MN 55102, USA
| | | | | | | |
Collapse
|
11
|
Zotta DC, Stati G, Paulis DD, Galzio RJ. Intrameatal aneurysm of the anterior inferior cerebellar artery. J Clin Neurosci 2011; 18:561-3. [DOI: 10.1016/j.jocn.2010.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/21/2010] [Indexed: 11/16/2022]
|
12
|
Päsler D, Baldauf J, Runge U, Schroeder HWS. Intrameatal thrombosed anterior inferior cerebellar artery aneurysm mimicking a vestibular schwannoma. J Neurosurg 2010; 114:1057-60. [PMID: 20964593 DOI: 10.3171/2010.9.jns10491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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 a rare entity. Purely intrameatal aneurysms are even rarer. The authors report an intrameatal thrombosed AICA aneurysm mimicking a vestibular schwannoma that was treated by resection and end-to-end anastomosis. This 22-year-old man presented with acute hearing loss, vertigo, and moderate facial palsy. Magnetic resonance imaging showed an atypical intrameatal lesion with dilation of the internal auditory canal. Microsurgical inspection via a retrosigmoid approach and drilling of the posterior wall of the internal auditory canal revealed a thrombosed AICA aneurysm. The aneurysm was excised, and an end-to-end suture was performed to restore AICA continuity. Intraoperative indocyanine green videoangiography as well as postoperative digital substraction angiography showed a good revascularization. Intrameatal AICA aneurysms may present with symptoms similar to vestibular schwannomas. End-to-end reanastomosis after aneurysm resection is a treatment option when clipping is impossible.
Collapse
Affiliation(s)
- Dennis Päsler
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany.
| | | | | | | |
Collapse
|
13
|
Ruptured intrameatal AICA aneurysms--a report of two cases and review of the literature. Acta Neurochir (Wien) 2009; 151:1525-30. [PMID: 19513583 DOI: 10.1007/s00701-009-0269-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 03/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aneurysms of the distal part of the anterior-inferior cerebellar artery (AICA) are rare. Most are located in the cerebellopontine angle close to the internal auditory meatus. To our knowledge, only 13 patients with the aneurysm located inside the internal auditory meatus have been reported in the literature. METHOD AND FINDINGS We present two cases of ruptured intrameatal AICA aneurysms that were treated in our center in the past year. The locations and clinical manifestations are discussed and all 13 previously published cases are reviewed. CONCLUSION Exposure and decompression of all structures in the internal auditory meatus, careful manipulation of the nerves and vessels, temporary trapping of the aneurysm, and careful dissection of the neck to avoid partial clipping are the essential steps when treating intrameatal AICA aneurysms to reduce the risk of postoperative neurological deficits.
Collapse
|
14
|
|
15
|
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: 12] [Impact Index Per Article: 0.8] [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.
Collapse
Affiliation(s)
- Xianli Lv
- Beijing Neurosurgical Institute; Beijing, China - Beijing Tiantan Hospital, Capital Medical University; Beijing, China -
| | | | | | | | | |
Collapse
|
16
|
Bonneville F, Savatovsky J, Chiras J. Imaging of cerebellopontine angle lesions: an update. Part 1: enhancing extra-axial lesions. Eur Radiol 2007; 17:2472-82. [PMID: 17562049 DOI: 10.1007/s00330-007-0679-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 04/24/2007] [Accepted: 04/27/2007] [Indexed: 11/26/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging reliably demonstrate typical features of vestibular schwannomas or meningiomas in the vast majority of mass lesions in the cerebellopontine angle (CPA). However, a large variety of unusual lesions can also be encountered in the CPA. Covering the entire spectrum of lesions potentially found in the CPA, these articles explain the pertinent neuroimaging features that radiologists need to know to make clinically relevant diagnoses in these cases, including data from diffusion and perfusion-weighted imaging or MR spectroscopy, when available. A diagnostic algorithm based on the lesion's site of origin, shape and margins, density, signal intensity and contrast material uptake is also proposed. Part 1 describes the different enhancing extra-axial CPA masses primarily arising from the cerebellopontine cistern and its contents, including vestibular and non-vestibular schwannomas, meningioma, metastasis, aneurysm, tuberculosis and other miscellaneous meningeal lesions.
Collapse
Affiliation(s)
- Fabrice Bonneville
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
| | | | | |
Collapse
|
17
|
Abstract
The outcome of intracranial aneurysms remains disastrous despite progress in diagnosis, management, care, and follow-up. This article discusses the pathology, the etiologies, the epidemiology and the classifications of intracranial aneurysms.
Collapse
Affiliation(s)
- Fabrice Bonneville
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013 Paris, France.
| | | | | |
Collapse
|
18
|
Holst B, Grunwald IQ, Brill G, Reith W. Differenzialdiagnose von Raumforderungen im Kleinhirnbr�ckenwinkel. Radiologe 2004; 44:1113-36; quiz 1137. [PMID: 15526182 DOI: 10.1007/s00117-004-1131-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Most of the space demands in the cerebellopontine angle lie extra-axially. Important structures run within the cisterns of the cerebellopontine angle, such as the trigeminal, facial and vestibulocochlear nerves as well as the anterior inferior and posterior inferior cerebellar arteries and the veins which lead to the petrosal sinus. The most common space demands are caused by acoustic neuromas, meningeomas, vascular ectasia and aneurysms. Less common are epidermoid and other schwannomas as well as metastases, paragangliomas and arachnoidal cysts. Intra-axial tumours in the area of the cerebellopontine angle include the medulloblastoma, astrocytoma and the ependymoma, which occurs predominantly in children, in addition to the uncommon choroid plexus papilloma. Nearby, there are also space demands around the petrous bone, such as cholesterol granuloma, malignant otitis media, paraganglioma and metastases. For differential diagnosis, an understanding of the space requirements of the tumours in the cerebellopontine angle is needed in addition to knowledge of the anatomical structures.
Collapse
Affiliation(s)
- B Holst
- Institut für Bildgebende Diagnostik und Interventionen, Klinikum Saarbrücken gGmbH
| | | | | | | |
Collapse
|