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Karadimas SK, Wu EM, Elarjani T, Morcos JJ. Treatment of Recurrent, Twice Coiled, Previously Ruptured Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery Aneurysm With Excision and End-to-End Anastomosis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01189. [PMID: 38888312 DOI: 10.1227/ons.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 06/20/2024] Open
Abstract
Anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) variant is a well-established variant of the vertebrobasilar system. AICA-PICA aneurysms are extremely rare.1-3 There are only 12 cases reported in the literature.1-3 Here, we are presenting a case of a previously ruptured AICA-PICA dissecting aneurysm which had undergone coil embolization twice at an outside institution. The aneurysm continued to grow, and therefore, the patient was transferred to our institution for definitive treatment. Placement of a flow diverter was felt not to be feasible because of the acute bend of the vessel at the neck of the aneurysm. After a retrosigmoid craniotomy, the aneurysm sac was opened to untether the coil mass from the neck of the aneurysm. Clip reconstruction was attempted but intraoperative blood flow measurements demonstrated no flow in the distal outflow artery, indicating that the clip was occluding the parent vessel at the neck because of the challenging geometry and atherosclerosis. We then proceeded with an excision and end-to-end anastomosis of the AICA-PICA. The details of vascular reconstruction while the inflow and outflow arteries are at acute angle are described. Intraoperative indocyanine video angiography demonstrated complete exclusion of the aneurysm from the circulation and patency of the bypass. Postoperative computed tomography angiography demonstrated bypass patency. Postoperatively, the patient required a temporary external ventricular drain for hydrocephalus; however, she was eventually discharged home without any neurological deficits. The patient gave informed consent for the surgery and video recording. Institutional Review Board approval was deemed unnecessary.
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Affiliation(s)
- Spyridon K Karadimas
- Department of Neurosurgery, Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Eva M Wu
- Department of Neurosurgery, Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Turki Elarjani
- Department of Neurosurgery, Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jacques J Morcos
- Department of Neurosurgery, Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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2
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Sreenivasan S, Roychowdhury S, Kashibathla A, Kumarapuram S, Nourollah-Zadeh E, Sundararajan S, Sun H, Nanda A, Gupta G. Flow Diversion for Treatment of Anterior Inferior Cerebellar Artery Aneurysms: Mechanism and Pitfalls from a Novel Management Strategy. World Neurosurg 2024; 182:e163-e170. [PMID: 37992994 DOI: 10.1016/j.wneu.2023.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Anterior inferior cerebellar artery (AICA) aneurysms present a challenge for neurosurgeons and neurointerventionalists alike. METHODS Cases of AICA aneurysms managed with endovascular flow diversion at our institute are reviewed with their angiographic outcomes. RESULTS Both direct and indirect flow diversion provide complete aneurysm occlusion at follow-up. We propose a stratified method of approaching AICA aneurysms based on location, rupture status, and neck size. CONCLUSIONS Careful evaluation of preoperative parameters is paramount in deciding between a surgical or a neuroendovascular approach. Low-profile stents in the future may assist in direct flow diversion of AICA trunk aneurysms. In addition, neurosurgeons need to be well versed in endovascular approaches.
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Affiliation(s)
- Sanjeev Sreenivasan
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Sudipta Roychowdhury
- Department of Interventional Radiology, University Radiology, Robert Wood Johnson Medical School, New Jersey, USA
| | - Ananth Kashibathla
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Siddhant Kumarapuram
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Emad Nourollah-Zadeh
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Srihari Sundararajan
- Department of Interventional Radiology, University Radiology, Robert Wood Johnson Medical School, New Jersey, USA
| | - Hai Sun
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Anil Nanda
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA.
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3
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Ku JC, Chavda V, Palmisciano P, Pasarikovski CR, Yang VX, Kiwan R, Priola SM, Chaurasia B. Endovascular treatment for anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) common trunk variant aneurysms: Technical note and literature review. J Cerebrovasc Endovasc Neurosurg 2023; 25:452-461. [PMID: 37041684 PMCID: PMC10774679 DOI: 10.7461/jcen.2023.e2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/27/2022] [Accepted: 02/26/2023] [Indexed: 04/13/2023] Open
Abstract
The Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) common trunk is a rare variant of cerebral posterior circulation in which a single vessel originating from either the basilar or vertebral arteries supplies both cerebellum and brainstem territories. We present the first case of an unruptured right AICA-PICA aneurysm treated with flow diversion using a Shield-enhanced pipeline endovascular device (PED, VANTAGE Embolization Device with Shield Technology, Medtronic, Canada). We expand on this anatomic variant and review the relevant literature. A 39-year-old man presented to our treatment center with vertigo and right hypoacusis. The initial head CT/CTA was negative, but a 4-month follow-up MRI revealed a 9 mm fusiform dissecting aneurysm of the right AICA. The patient underwent a repeat head CTA and cerebral angiogram, which demonstrated the presence of an aneurysm on the proximal portion of an AICA-PICA anatomical variant. This was treated with an endovascular approach that included flow diversion via a PED equipped with Shield Technology. The patient's post-procedure period was uneventful, and he was discharged home after two days with an intact neurological status. The patient is still asymptomatic after a 7-month follow-up, with MR angiogram evidence of stable aneurysm obliteration and no ischemic lesions. Aneurysms of the AICA-PICA common trunk variants have a high morbidity risk due to the importance and extent of the territory vascularized by a single vessel. Endovascular treatment with flow diversion proved to be both safe and effective in obliterating unruptured cases.
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Affiliation(s)
- Jerry C. Ku
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Centre, Stanford, CA, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | | | - Victor X.D. Yang
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ruba Kiwan
- Department of Radiology, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Stefano M. Priola
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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4
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Han Q, Wang Z, Liu T, Huang Y. Resection of ruptured aneurysm associated with bilateral anomalous posterior inferior cerebellar anastomotic arteries: case report and review of literature. Front Neurol 2023; 14:1281124. [PMID: 38107645 PMCID: PMC10722183 DOI: 10.3389/fneur.2023.1281124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Aneurysms on the posterior inferior cerebellar artery (PICA) may not be the major part of intracranial aneurysm. Especially, an aneurysm located on the bilateral posterior inferior cerebellar anastomotic artery has abnormal anatomical characteristics in the vessel wall and then causes stroke including subarachnoid hemorrhage. This case report explores the direct resection of a ruptured aneurysm associated with the bilateral anomalous anastomotic artery of PICA. Methods The case report discusses a 53-year-old woman who suffered from sudden severe headache and vomiting for more than 3 h admitted to our hospital. Emergency computed tomography (CT) revealed subarachnoid hemorrhage (SAH) in the third and fourth ventricles. Preoperative 3 Dimensions-digital subtraction angiography (3-D DSA) indicated a ruptured aneurysm located on the bilateral posterior inferior cerebellar anastomotic artery. Postoperative pathological findings indicated the characteristics of parent artery PICA and control aneurysm. The authors performed an overview of PICA aneurysms with anomalous variation in the Pubmed, Web of Science, and Medline databases. The search was until 1 August 2023. Related terms "posterior inferior cerebellar artery" And "aneurysm" AND "anatomical variants" were used to search the review. The reasons for anomalous variation anastomosis between bilateral PICAs were analyzed. Results The aneurysm was resected successfully. Post-operative 3-D DSA revealed the disappearance of the aneurysm. The vessel wall of anastomotic PICA showed neovascularized hyperplasia, abnormal arrangement of smooth muscle, CD31+ endothelial cells, and SMA+ smooth muscle cells. In contrast, when it came to aneurysm, the wall at the location of the fracture thinned, which could be used to explain that the local nodular protrusion was formed and CD31+ endothelial cells existed. No neurological deficits were found at her 1-year follow-up visit (mRS score of 0). Conclusion Direct resection of ruptured aneurysm associated with bilateral anomalous posterior inferior cerebellar anastomotic arteries was an effective treatment and careful consideration of the anatomical characteristics concerning the interesting aneurysm and the variant PICA was critical for sate treatment. Also, the literature on the lesion was reviewed.
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Affiliation(s)
- Qingdong Han
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zongqi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tong Liu
- Department of Pathology, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, Shandong, China
| | - Yabo Huang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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5
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Quach ET, Dehdashti AR. Posterior Inferior Cerebellar Artery Excision and End-to-End Reanastomosis for Treatment of a Giant, Partially Thrombosed Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e219-e220. [PMID: 37345921 DOI: 10.1227/ons.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/17/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Eric T Quach
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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6
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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.
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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
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7
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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.
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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
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8
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Scullen T, Mathkour M, Dumont A, Glennon S, Wang A. Intracranial Aneurysms in the Context of Variant Cerebrovascular Anatomy: A Review of the Literature. World Neurosurg 2022; 165:58-68. [PMID: 35659590 DOI: 10.1016/j.wneu.2022.05.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Tyler Scullen
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121
| | - Mansour Mathkour
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121
| | - Aaron Dumont
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130
| | - Stephen Glennon
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121
| | - Arthur Wang
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70130
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Kimura S, Yagi R, Kishi F, Ogawa D, Yamada K, Taniguchi H, Wanibuchi M. Subarachnoid hemorrhage due to ruptured cerebral aneurysm at the distal part of anterior inferior cerebellar artery-posterior inferior cerebellar artery variant after γ-knife irradiation. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Vertebrobasilar Infarction Due to Bow Hunter's Syndrome in a Patient with Rheumatoid Arthritis: A Case Report. J UOEH 2021; 43:349-353. [PMID: 34483194 DOI: 10.7888/juoeh.43.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 60-year-old woman with a 37-year history of rheumatoid arthritis (RA) had a sudden onset of headache. Head MRI showed acute multiple infarctions in the vertebrobasilar region, and MR angiography showed stenosis of the right vertebral artery (VA). 3D-CT angiography of the craniovertebral junction showed atlantoaxial subluxation and stenosis of the right VA just distal to the transverse foramen of C2, which was due to osteophytes and degenerative changes secondary to RA. Digital subtraction angiography clearly demonstrated occlusion of the right VA during rightward head rotation. Based on those findings, rotatory instability at C1-2 was considered as the primary cause of the vertebrobasilar infarctions, and Bow Hunter's syndrome was diagnosed. The patient underwent C1-5 posterior fixation, and brain infarction has not recurred.
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11
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Eichberg DG, Komotar RJ, Sur S. Commentary: Retrosigmoid Clip Anterior Inferior Cerebellar Artery Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E181-E182. [PMID: 32022869 DOI: 10.1093/ons/opaa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Samir Sur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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12
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Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ. Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature. Int J Med Sci 2020; 17:3005-3019. [PMID: 33173421 PMCID: PMC7646108 DOI: 10.7150/ijms.49137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022] Open
Abstract
The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. However, a comprehensive systematic review of the importance of the PICA is currently lacking. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. The PICA has tortuous and variable course and territory, divided into 5 segments. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. PICA injured by head trauma can cause fatal SAH. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. In conclusion, PICA is very important in clinical practice.
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Affiliation(s)
- Hui-Lei Miao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China.,Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Deng-Yan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China.,School of General Practice and Continuing Education, Capital Medical University, Beijing 100069,China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Xiao-Tian Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Li-Qun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
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13
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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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14
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Suzuki T, Okamoto K, Genkai N, Ito Y, Abe H. Multiple aneurysms on the subarcuate artery arising from the anterior inferior cerebellar artery in a patient with a Borden type I transverse-sigmoid dural arteriovenous fistula manifesting as subarachnoid hemorrhage: A case report. Interv Neuroradiol 2019; 25:90-96. [PMID: 30227805 PMCID: PMC6378525 DOI: 10.1177/1591019918799299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/15/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare and commonly associated with vascular malformations, such as cerebellar arteriovenous malformations (AVMs). We present a case wherein multiple AICA feeding aneurysms on the subarcuate artery as a feeding artery of a Borden type I transverse-sigmoid dural arteriovenous fistula (dAVF) manifested as subarachnoid hemorrhage. CASE DESCRIPTION A 67-year-old woman presented with acute severe headache. Brain computed tomography (CT) demonstrated subarachnoid hemorrhage mainly in the posterior fossa. A transverse-sigmoid dAVF was detected on magnetic resonance angiography (MRA) and three-dimensional-CT angiography (3D-CTA), with no cortical venous reflex. The patient underwent conventional angiography, which showed multiple aneurysms on a small branch of the AICA, feeding a transverse-sigmoid dAVF (Borden type I). The AICA aneurysms seemed flow dependent and ruptured owing to high-flow arteriovenous shunts through the dAVF. Based on the source images of the MRA, the small artery arising from the AICA was considered the subarcuate artery, and it was confirmed on 3D-CTA after the artery was successfully embolized with Onyx without any complications. Multiple aneurysms on the subarcuate artery are extremely rare, and the artery has not been identified as a feeding artery of the transverse-sigmoid dAVF. CONCLUSION A rare case of multiple ruptured aneurysms on the subarcuate artery was reported in a patient with a Borden type I dAVF at the transverse-sigmoid sinuses manifesting as subarachnoid hemorrhage. Onyx embolization of the parent artery occlusion was feasible and useful in treating this type of feeding artery aneurysm of the AICA with a dAVF.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kouichirou Okamoto
- Department of Translational Research, Brain Research Institute, Niigata University, Niigata, Japan
| | - Nobuyuki Genkai
- Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yasushi Ito
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
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15
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Ansari KA, Menon G, Nair S, Abraham M. Aneurysm of Anterior Inferior Cerebellar Artery-posterior Inferior Cerebellar Artery Variant. Asian J Neurosurg 2018; 13:53-55. [PMID: 29492120 PMCID: PMC5820894 DOI: 10.4103/1793-5482.180935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aneurysms arising from anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) variant are extremely rare. They usually present with subarachnoid hemorrhage. This is probably the second case report of a large thrombosed AICA-PICA variant aneurysm presenting as a cerebellopontine angle mass lesion with cranial nerve palsy, managed successfully by surgical clipping.
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Affiliation(s)
- Khursheed Ahmad Ansari
- Department of Neurosurgery, Wockhardt Hospitals, The Umrao Institute of Medical Sciences and Research, North Mumbai, Maharashtra, India
| | - Girish Menon
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Suresh Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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16
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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.
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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
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17
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Maeda K, Motoie R, Karashima S, Otsuji R, Ren N, Nagaoka S, Ikai Y, Uno J, Gi H. A case with coil embolization for ruptured aneurysm associated with fenestration of the posterior inferior cerebellar artery. Interv Neuroradiol 2017; 23:632-635. [PMID: 28893126 DOI: 10.1177/1591019917729365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An 87-year-old man hospitalized for subarachnoid hemorrhage showed a ruptured aneurysm arising from fenestration of the posterior inferior cerebellar artery. Endovascular treatment was selected and the aneurysm and superior limb were embolized completely using three coils. Fenestration of the posterior cerebellar artery is exceedingly rare. In addition, we present a first case of aneurysm as fenestration of the posterior inferior cerebellar artery that was definitively identified as a cause of bleeding.
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Affiliation(s)
- Kazushi Maeda
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Ryota Motoie
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | | | - Ryosuke Otsuji
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Nice Ren
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Shintaro Nagaoka
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Yoshiaki Ikai
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Junji Uno
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
| | - Hidefuku Gi
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
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18
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Shimano H, Kondo A, Yasuda S, Inoue H, Morioka J, Miwa H, Kawakami O, Murao K. Significance of Anomalous Anterior Inferior Cerebellar Artery–Posterior Inferior Cerebellar Artery Common Trunk Compression in Microvascular Decompression for Hemifacial Spasm. World Neurosurg 2016; 92:15-22. [DOI: 10.1016/j.wneu.2016.04.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/28/2022]
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19
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Akhtar S, Azeem A, Jiwani A, Javed G. Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: Case report and review of literature. Int J Surg Case Rep 2016; 22:23-7. [PMID: 27017276 PMCID: PMC4844662 DOI: 10.1016/j.ijscr.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 11/26/2022] Open
Abstract
We reported a case of an aneurysm in the AICA-PICA variant which was subsequently excised. Considerable variation exists in the anatomy of the vertebrobasilar system. Understanding the variations and the aneurysms that may arise from them is an important aspect of neurosurgical practice.
Introduction There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20–24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature. Presentation of case We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically. Discussion Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below. Conclusion The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty.
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Affiliation(s)
- Saad Akhtar
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Abdul Azeem
- Medical College, The Aga Khan University, Karachi, Pakistan.
| | - Amyna Jiwani
- Section of General Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Gohar Javed
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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20
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Park WB, Sung JH, Huh J, Cho CB, Yang SH, Kim IS, Hong JT, Lee SW. Double Stent Assist Coiling of Ruptured Large Saccular Aneurysm in Proximal Basilar Artery Fenestration. J Cerebrovasc Endovasc Neurosurg 2015; 17:227-33. [PMID: 26523257 PMCID: PMC4626347 DOI: 10.7461/jcen.2015.17.3.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/24/2015] [Accepted: 09/10/2015] [Indexed: 11/23/2022] Open
Abstract
Basilar artery fenestration is infrequent and even rarer in association with a large aneurysm. With proximity to brain stem and vital perforators, endovascular coiling can be considered first. If the large ruptured aneurysm with a wide neck originated from fenestra of the proximal basilar artery and the fenestration loop has branches of posterior circulation, therapeutic consideration should be thorough and fractionized. We report endovascular therapeutic details for a case of a ruptured large saccular aneurysm in proximal basilar artery fenestration.
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Affiliation(s)
- Woong Bae Park
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Joon Huh
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Chul Bum Cho
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seung Ho Yang
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Il Sup Kim
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang Won Lee
- Cerebrovascular center, Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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21
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Ooigawa H, Morikawa E, Ishihara S, Ogura T, Takeda R, Kurita H. Partially thrombosed giant aneurysm arising from a distal anterior inferior cerebellar artery–posterior inferior cerebellar artery variant: A case report. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2015. [DOI: 10.1016/j.inat.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Shibahara I, Yonezawa S, Takazawa H, Kawaguchi T, Kanamori M, Murakami K, Midorikawa H, Sasaki T, Nishijima M. Ruptured peripheral aneurysms in a collateral pathway associated with stenosis of a major cerebral artery: Report of two cases. Surg Neurol Int 2011; 2:81. [PMID: 21748034 PMCID: PMC3130464 DOI: 10.4103/2152-7806.82247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/29/2011] [Indexed: 11/11/2022] Open
Abstract
Background While hemodynamic stress can result in aneurysm formation, it rarely contributes to the development of peripheral aneurysms in collateral pathways. We report two patients with ruptured distal aneurysms in a collateral pathway associated with stenosis of a major cerebral artery. Case Description A 67-year-old man presented with intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) revealed severe stenosis of the right middle cerebral artery and two aneurysms in the collateral pathway of the right anterior cerebral artery. The ruptured aneurysm was trapped and resected; histologically, it was a true saccular aneurysm. The unruptured aneurysm was clipped and the patient was discharged without additional neurological deficits. The second patient was a 73-year-old woman with subarachnoid hemorrhage. DSA revealed three arterial dilations. On the 7th day of hospitalization, one of the aneurysms in a posterior inferior cerebellar artery–anterior inferior cerebellar artery anastomosis that functioned as a collateral pathway in the presence of severe basilar artery stenosis was found to be enlarged. It was treated by selective aneurysmal coil embolization with parent artery preservation. Her postoperative course was uneventful and she was discharged without any neurological deficits. Conclusion We document the successful treatment of two patients with ruptured aneurysms in the peripheral portion of a collateral pathway. We discuss the histology of peripheral aneurysms and present a review of the literature.
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Affiliation(s)
- Ichiyo Shibahara
- Department of Neurosurgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-tsukurimichi, Aomori, Japan 030-8553
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23
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Suh SH, Kim DJ, Kim DI, Kim BM, Chung TS, Hong CK, Jung JY. Management of anterior inferior cerebellar artery aneurysms: endovascular treatment and clinical outcome. AJNR Am J Neuroradiol 2010; 32:159-64. [PMID: 21051509 DOI: 10.3174/ajnr.a2360] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE AICA aneurysms are rare and a challenge to treat surgically. We present our experience of the angiographic results and the clinical outcomes for 9 AICA aneurysms treated by EVT. MATERIALS AND METHODS Between 1997 and 2009, EVT was attempted for 9 AICA aneurysms. Six patients presented with SAH, and 3 aneurysms were found incidentally. The location of the aneurysms was the proximal AICA in 7 and the distal AICA in 2. Five aneurysms originated from an AICA-PICA variant. Clinical outcomes and procedural complications were evaluated, and angiography was performed 6, 12, and 24 months after embolization to confirm recanalization of the coiled aneurysm. RESULTS EVT was technically successful in 7 patients (78%). Surgical trapping was performed in 1 patient after failure of EVT, and another aneurysm occluded spontaneously, along with the parent artery during EVT. In 7 patients, the AICAs had good patency on postoperative angiography. Stent-assisted coiling was performed in 3 patients. Follow-up angiographies were performed in 7 patients and showed no evidence of recanalization or progressive occlusion with further thrombosis except in 1 patient. There was no evidence of aneurysm rupture during the follow-up period, and 8 patients were able to perform all usual activities (mRS score, 0-1). CONCLUSIONS EVT may provide a feasible and safe option as an alternative, though a microsurgical option is initially considered for the management of AICA aneurysms. Further follow-up and more experience are also necessary.
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Affiliation(s)
- S H Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea
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24
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Gopalakrishnan CV, Menon G, Nair S. Aneurysm of the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: two case reports and review of literature. Br J Neurosurg 2009; 23:554-6. [PMID: 19669982 DOI: 10.1080/02688690902987778] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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