de Macêdo LP, Baptista-André DC, Ugulino-Netto A, Franke K, Oliveira Eugênio PV, Cezar-Junior AB, Faquini IV, de Carvalho-Júnior EV, Almeida NS, Azevedo-Filho HRC. Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report.
J Cerebrovasc Endovasc Neurosurg 2023:jcen.2023.E2023.05.006. [PMID:
38151969 DOI:
10.7461/jcen.2023.e2023.05.006]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 12/29/2023] Open
Abstract
Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.
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