The Superior Cerebellar Artery Aneurysm: A Posterior Circulation Aneurysm with Favorable Microsurgical Outcomes

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 908-916 ◽  
Author(s):  
Ana Rodríguez-Hernández ◽  
Brian P. Walcott ◽  
Harjus Birk ◽  
Michael T. Lawton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Techniques ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Microsurgical Clipping ◽  
Cerebellar Artery ◽  
Neurological Morbidity ◽  
Scale Scores ◽  
Permanent Morbidity

Abstract BACKGROUND: Superior cerebellar artery (SCA) aneurysms are usually grouped with aneurysms that arise from the upper basilar artery or more broadly, the posterior circulation. However, the SCA aneurysm has distinctive anatomy that facilitates safe surgical management, notably few associated perforating arteries, and excellent exposure in the carotid-oculomotor triangle. OBJECTIVE: To demonstrate the outcomes of patients treated with microsurgery in a continuous surgical series. METHODS: Sixty-two patients harboring 63 SCA aneurysms were retrospectively reviewed from a prospectively maintained database, focusing on clinical characteristics, surgical techniques, and clinical outcomes. RESULTS: Of 31 patients (49%) presenting with subarachnoid hemorrhage, the SCA aneurysm was the source in 16 (25%). Thirty-three aneurysms were complex (52%) and 43 patients (59%) had multiple aneurysms. Fifty-seven SCA aneurysms (90.5%) were clipped and 5 were bypassed/trapped or wrapped. Complete angiographic occlusion was achieved in 91.7%. Permanent neurological morbidity occurred in 3 patients and 3 patients that presented in coma after subarachnoid hemorrhage died. All patients with “simple” aneurysms and without subarachnoid hemorrhage had improved or unchanged modified Rankin scale scores. Overall, outcomes were stable or improved in 82.5% of patients. CONCLUSION: SCA aneurysms are favorable for microsurgical clipping with low rates of permanent morbidity and mortality. Microsurgery should be considered alongside endovascular techniques as a treatment option in many patients.

Traumatic Aneurysm of the Superior Cerebellar Artery: Case Report and Review of the Literature

Neurosurgery ◽  
1990 ◽  
Vol 27 (3) ◽  
pp. 476-479 ◽  
Author(s):  
Keith B. Quattrocchi ◽  
Surl L. Nielsen ◽  
Virginia Poirier ◽  
Franklin C. Wagner
Keyword(s):  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Review Of The Literature ◽  
Imaging Studies ◽  
Traumatic Aneurysm ◽  
Computed Tomographic ◽  
Cerebellar Artery ◽  
Computed Tomographic Scan ◽  
Traumatic Aneurysms

Abstract Less than 10% of the 250 reported cases of traumatic intracranial aneurysms have involved the posterior circulation. Traumatic aneurysms of the superior cerebellar artery are extremely rare, with only three cases previously reported. This is the first report of a traumatic superior cerebellar artery aneurysm in which the diagnosis was suggested by computed tomographic scan. The potential for a good outcome suggests the value of early angiography when the history and diagnostic imaging studies suggest the possibility of a traumatic aneurysm.

scholarly journals Acute surgery for a case of superior vermian arteriovenous malformation producing raised venous pressure coexisting with basilar-superior cerebellar artery aneurysm presenting subarachnoid hemorrhage; Case report

2021 ◽  
Vol 12 ◽  
pp. 23
Author(s):  
Sho Tsunoda ◽  
Tomohiro Inoue ◽  
Akihiro Shimoi ◽  
Atsuya Akabane
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformation ◽  
Cerebral Vasospasm ◽  
Acute Phase ◽  
Venous Pressure ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Oculomotor Palsy ◽  
Acute Surgery ◽  
Cerebellar Artery

Background: Superior vermian subtype of arteriovenous malformation (AVM) coexisting with proximal feeder aneurysm on basilar-superior cerebellar artery (BA-SCA) junction is an extremely rare situation. We experienced a case of this rare entity presenting with subarachnoid hemorrhage (SAH), and herein, introduce the outline and clinical features of this experience together with the actual surgical video. Case Description: A 54-year-old man SAH patient with severe headache, disturbance of consciousness, and left oculomotor palsy was urgently admitted to our hospital. Imaging examination demonstrated superior vermian AVM with BA-SCA aneurysm, and both lesions were treated through two different approaches (left pterional craniotomy in conjunction with zygomectomy, and left posterior interhemispheric occipital transtentorial approach) in acute phase of SAH. Both lesions were completely disappeared postoperatively and the patient’s postoperative course was favorable, without symptomatic cerebral vasospasm. Although slight oculomotor palsy remained, the patient recovered well and was transferred to a rehabilitation hospital for further improvement. Conclusion: In the cases of AVM coexisting with proximal feeder aneurysm, presenting with SAH, disorders of intracranial venous return associated with an AVM can be a vital hindrance to managing cerebral vasospasm; therefore, treating both lesions in the acute phase may lead to good outcomes.

scholarly journals Subarachnoid hemorrhage due to ruptured dissecting duplicated superior cerebellar artery aneurysm treated by endovascular embolization: a case report

Nosotchu ◽  
2013 ◽  
Vol 35 (3) ◽  
pp. 209-212
Author(s):  
Keisuke Enoki ◽  
Katsumi Matsumoto ◽  
Koichiro Tsuruzono ◽  
Manabu Sasaki ◽  
Yasunori Yoshimura ◽  
...  
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery

scholarly journals Transcavernous Approach for Microsurgical Clipping of Ruptured Right Superior Cerebellar Artery Aneurysm with Cadaveric Stepwise Video Illustration

2021 ◽  
Author(s):  
Edinson Najera ◽  
Baha'eddin A. Muhsen ◽  
Hamid Borghei-Razavi ◽  
Michal obrzut ◽  
Badih Adada
Keyword(s):  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Endovascular Coiling ◽  
Management Options ◽  
Anatomical Dissection ◽  
Microsurgical Clipping ◽  
Cerebellar Artery ◽  
Grade 3 ◽  
Neurovascular Anatomy

AbstractSuperior cerebellar artery (SCA) aneurysms are rare. The management options are not well defined. There is increasing role of endovascular treatment for all aneurysms, especially for aneurysms of the posterior circulation. However in some situations (wide base, dysmorphic features) coiling is not feasible. The surgical management of these aneurysms has its own distinct complexity and requires careful planning. The classic pterional or subtemporal approaches had its own limitation in proper visualization of the neurovascular anatomy.In this video, we describe the technical nuances of transcavernous sinus approach for microsurgical clipping SCA and A-comm aneurysms. We present the case of a 67-year-old RHF who presented with ruptured right-sided SCA aneurysm. She complained of Headache, confusion, and double vision. On physical examination, she had no focal deficits and was Hunt and Hess grade 3. A brain computed tomography (CT) scan revealed a subarachnoid hemorrhage Fisher's grade 4. A brain CT angiography (CTA) demonstrated an aneurysm at the origin of right SCA. The patient had failed attempt of endovascular coiling and she underwent microsurgical clipping.Stepwise demonstration of the approach with cadaveric anatomical dissection is illustrated. The technique presented here allows for safe clipping of the aneurysm through the cavernous sinus. The approach allows for good exposure of the aneurysm and the surrounding structures. Care is taken to visualize the perforators to avoid any devastating brain stem infarction during the clipping.The transcavernous sinus is a robust approach with good visualization of the neurovascular structures allowing safe aneurysm clipping in this location.The link to the video can be found at: https://youtu.be/oE-HyDASiKM.

scholarly journals Ruptured superior cerebellar artery aneurysm causing subarachnoid hemorrhage with supratentorial intracerebral hematoma: A case report

Nosotchu ◽  
2009 ◽  
Vol 31 (3) ◽  
pp. 168-172
Author(s):  
Atsushi Mizutani ◽  
Teiji Nakayama ◽  
Keisei Tanaka ◽  
Shinichiro Koizumi ◽  
Hiroki Namba
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Intracerebral Hematoma ◽  
Cerebellar Artery

RESULTS OF MICROSURGICAL CLIPPING OF 50 HIGH COMPLEXITY BASILARAPEX ANEURYSMS

Neurosurgery ◽  
2007 ◽  
Vol 60 (2) ◽  
pp. 242-252 ◽  
Author(s):  
Ali F. Krisht ◽  
Niklaus Krayenbühl ◽  
David Sercl ◽  
Kerem Bikmaz ◽  
Paulo A.S. Kadri
Keyword(s):  
Superior Cerebellar Artery ◽  
Related Complication ◽  
Free Zone ◽  
Microsurgical Clipping ◽  
Large Size ◽  
Cerebellar Artery ◽  
Scale Scores ◽  
Giant Size ◽  
Rate Of Failure

Abstract OBJECTIVE Complex basilar aneurysms (large size, wide base, low bifurcation, and dysmorphic posteriorly projecting domes) frequently fail endovascular treatment. We report our experience using the pretemporal transzygomatic transcavernous approach with 50 complex basilar aneurysms. METHODS Using the pretemporal transcavernous route, opening the occulomotor trigone, and removing the anterior clinoid and the posterior clinoid when necessary, a wide exposure of the interpeduncular fossa is achieved. Temporary clips are applied to a perforator-free zone of the basilar trunk, proximal to the superior cerebellar artery. Complexity criteria in the 50 aneurysms included large or giant size in 27 patients, wide dysmorphic base in 18 patients, low bifurcation in 21 patients, posteriorly projecting dome in 11 patients, and dolichoectasia of the apex in three patients. RESULTS Twenty-five patients presented with subarachnoid hemorrhage. There were 14 men and 36 women between the ages of 32 and 76 years (mean, 52.2 yr). Forty-nine aneurysms (98%) were successfully clipped. There was no procedure-related mortality. Two patients died (one from delayed bowel ischemia and one from a vasospasm-related complication). There were three ischemia-related events, two of which were procedure-related (medial thalamic lacunar infarct, superior cerebellar distribution ischemia) and one which was a third distal middle cerebral cardiac embolus after stopping Coumadin (DuPont Pharmaceuticals, Wilmington, DE) for atrial fibrillation. Transient partial or complete occulomotor palsies occurred in all patients with full recovery as the rule, except in one patient. At discharge, Glascow Outcome Scale scores were 4 or 5 in 88% of the patients. At the 6-month follow-up examination, Rankin Outcome Scale scores were 0 to 2 in 92% of the patients. CONCLUSION Our experience reintroduces microsurgery as a safe and more durable treatment option for the management of complex basilar apex aneurysms that tend to have a higher rate of failure with endovascular therapy.

Sign in / Sign up

Export Citation Format

Share Document