Operative Treatment of a Superior Cerebellar Artery Perforator Dissecting Aneurysm

2020 ◽  
Vol 19 (2) ◽  
pp. E203-E208
Author(s):  
Jonathan J Lee ◽  
Meng Huang ◽  
Jaime Guerrero ◽  
Virendra R Desai ◽  
Amanda Jenson ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Therapeutic Strategy ◽  
Dissecting Aneurysm ◽  
Superior Cerebellar Artery ◽  
Cerebral Angiogram ◽  
Suboccipital Craniotomy ◽  
Cerebellar Artery ◽  
Open Surgical Treatment ◽  
Artery Perforator

Abstract BACKGROUND AND IMPORTANCE Superior cerebellar artery (SCA) perforator aneurysms are extremely rare, with only one other case published in the literature. There is no conclusive management strategy for these aneurysms, although endovascular treatment, open surgical treatment with clipping, and antifibrinolytic administration with spontaneous thrombosis have all been discussed. CLINICAL PRESENTATION A 61-yr-old male presented with intraventricular hemorrhage (IVH) primarily in the posterior fossa. He was found to have a dissecting left SCA perforator aneurysm lying on the floor of the fourth ventricle. The aneurysm was not amenable to endovascular treatment, and antifibrinolytic therapy failed to spontaneously thrombose the aneurysm. We performed a suboccipital craniotomy and used a supracerebellar transvermian approach to resect the aneurysm. There was total obliteration of the aneurysm on postoperative cerebral angiogram. CONCLUSION SCA perforator aneurysms represent an extremely uncommon subset of intracranial aneurysms. The best therapeutic strategy has yet to be definitively proven. When pursuing surgical treatment, the supracerebellar transvermian navigated approach can be a useful and safe option, as described and illustrated in this video.

scholarly journals Surgical Treatment of A Dissecting Aneurysm of the Superior Cerebellar Artery: Case Report

2014 ◽  
Vol 21 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Florin Stefanescu ◽  
Stefanita Dima ◽  
Mugurel Petrinel Radoi
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Artery Aneurysm ◽  
Peripheral Region ◽  
Dissecting Aneurysm ◽  
Superior Cerebellar Artery ◽  
Surgical Clipping ◽  
Cerebellar Artery

Abstract Dissecting aneurysm located in the peripheral region of the superior cerebellar artery is very rare. There is little experience regarding their surgical or endovascular treatment. We present the case of a peripheral dissecting superior cerebellar artery aneurysm treated by surgical clipping.

scholarly journals Dissecting aneurysm of the distal superior cerebellar artery – Case report and assessment of endovascular treatment

2013 ◽  
Vol 32 (02) ◽  
pp. 118-121
Author(s):  
Arquimedes Cavalcante Cardoso ◽  
Eduardo Leitão de Almeida Lima ◽  
Thiago Mendes Barbosa
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Endovascular Therapy ◽  
Distal Portion ◽  
Endovascular Embolization ◽  
Dissecting Aneurysm ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Type Of Injury ◽  
Dissecting Aneurysms

AbstractDissecting aneurysms located in peripheral regions of the cerebellar arteries are rare, and few cases have been described in the literature. Surgical treatment of these lesions may become difficult due to its relatively inaccessible location. Thus, the approach of these aneurysms through endovascular therapy may be an alternative treatment. We described a case of ruptured dissecting aneurysm located in the distal portion of the superior cerebellar artery, which was treated with endovascular embolization. We also discuss the results of endovascular therapy for this type of injury.

scholarly journals Endovascular Treatment of a Small Aneurysm of the Superior Cerebellar Artery with a Flow-Diverter Device

2013 ◽  
Vol 26 (3) ◽  
pp. 327-331 ◽  
Author(s):  
F. Briganti ◽  
M. Marseglia ◽  
G. Leone ◽  
G. Briganti ◽  
D. Piccolo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Flow Diverter ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Small Aneurysm ◽  
Flow Diverter Device

scholarly journals Anterior inferior cerebellar artery aneurysms: Segments and results of surgical and endovascular managements

2016 ◽  
Vol 22 (6) ◽  
pp. 643-648 ◽  
Author(s):  
Xianli Lv ◽  
Huijian Ge ◽  
Hongwei He ◽  
Chuhan Jiang ◽  
Youxiang Li
Keyword(s):  
Hearing Loss ◽  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Patient Outcomes ◽  
Facial Palsy ◽  
Artery Aneurysm ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Cerebellar Symptoms

Background Anterior inferior cerebellar artery (AICA) aneurysms are rare and published clinical experience with these aneurysms is limited. Objective The objective of this article is to report angiographic characteristics and results associated with premeatal, meatal and postmeatal segments, surgical and endovascular therapies. Methods A literature review was performed through PubMed using “anterior inferior cerebellar artery aneurysm” through January 2016. Clinical data, angiograms, management techniques, and patient outcomes were reviewed for 47 collected cases in 30 previous reports. Results Of these aneurysms, 21 (44.7%) were associated with meatal segment, 10 (21.3%) were postmeatal and 16 (34.0%) were premeatal. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy (77.8%). Patient outcomes of meatal aneurysms presented with more neuropathies (51.7%) and cerebellar symptoms (14.3%) ( p = 0.049). Four cases of meatal aneurysm with preoperative cranial nerve deficits (two VII and two VIII) showed improvement after surgery. Endovascular treatment achieved outcomes similar to surgical treatment ( p = 0.327). Conclusions AICA aneurysms have a predilection for meatal segment. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy. Patient outcomes of meatal aneurysms presented with more neuropathies and cerebellar symptoms. Endovascular treatment achieved outcomes similar to surgical treatment.

scholarly journals Endovascular treatment of superior cerebellar artery aneurisms

2020 ◽  
Vol 22 (2) ◽  
pp. 25-32
Author(s):  
V. S. Kiselev ◽  
R. R. Gafurov ◽  
A. M. Perfilyev ◽  
A. О. Sosnov
Keyword(s):  
Endovascular Treatment ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery

Surgical Treatment of a Double Origin Posterior Inferior Cerebellar Artery Aneurysm and Insights From Embryology: Case Report and Literature Review

2017 ◽  
Vol 13 (3) ◽  
pp. E8-E12 ◽  
Author(s):  
Michael A. Silva ◽  
Alfred P. See ◽  
Mohammad A. Aziz-Sultan ◽  
Nirav J. Patel
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Cerebellar Artery ◽  
Flow Through ◽  
Open Surgical Treatment ◽  
Double Origin ◽  
Insight Into

Abstract BACKGROUND AND IMPORTANCE: Aneurysms affecting double origin (DO) posterior inferior cerebellar artery (PICA) variants are rare. Most reports describe endovascular occlusion of the affected branch to treat the aneurysm, but we describe a patient in which open surgical sacrifice of 1 branch resulted in insufficient perfusion. This case and our review of PICA embryology provide insight into treatment of aneurysms affecting duplicated intracranial vessels. CLINICAL PRESENTATION: We report the only case of open surgical treatment of an aneurysm affecting a leg of a DOPICA. A 42-year-old woman presenting with the worst headache of her life was found to have a DOPICA aneurysm and initially treated by trapping the aneurysm. Intraoperative indocyanine green imaging revealed insufficient perfusion through the caudal branch, which was remediated by end-to-end anastomosis to preserve flow through both origins. The patient made a full recovery. CONCLUSION: Treating a DOPICA aneurysm by sacrificing 1 of the origins is not possible for all patients. This first report of open surgical treatment of a DOPICA leg aneurysm suggests that 1 or both branches may be required for sufficient perfusion, and the unique embryology of DOPICA development suggests a possible mechanism.

scholarly journals Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

2018 ◽  
Vol 37 (01) ◽  
pp. 27-37
Author(s):  
Vitor Yamaki ◽  
Eric Paschoal ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Posterior Circulation ◽  
Surgical Approaches ◽  
Superior Cerebellar Artery ◽  
Anterior Circulation ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

scholarly journals Case Report: Endovascular Treatment of a Giant Distal PICA Aneurysm in Association With a Cerebellar AVM: A Report on Treatment Considerations and a Literature Review

2020 ◽  
Vol 11 ◽  
Author(s):  
Hassan A. Khayat ◽  
Christine M. Hawkes ◽  
Almunder R. Algird
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Management Approach ◽  
Parent Vessel ◽  
Cerebral Angiogram ◽  
First Case ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
The Right ◽  
Pica Aneurysms

Background: Distal posterior inferior cerebellar artery (PICA) aneurysms are uncommon intracranial vascular lesions. The coincidence of these aneurysms and Arteriovenous malformation (AVM) is even more rare. Since 1956, a total of 57 cases of distal PICA aneurysms associated with AVM have been reported with clear and adequate description. None of these reports describe a giant prenidal aneurysm at this particular location. The paucity of natural history data as well as lack of consensus about treatment strategies in such cases present a significant challenge that requires an individualized management approach.Case Description: A 68-year-old male presented with recurrent episodes of nausea and vomiting precipitated by physical exertion and change of head position. An MRI of the brain demonstrated a giant partially thrombosed right posterior inferior cerebellar artery (PICA) aneurysm with mass effect on the floor of the fourth ventricle. A conventional cerebral angiogram revealed a giant (3.1 x 3.1 x 2.8cm) distal right PICA pre-nidal aneurysm with two smaller distal PICA aneurysms. An AVM (Spetzler-Martin Grade 1) supplied by the right PICA as well as the right superior cerebellar artery (SCA) was also identified on cerebral angiography (not seen on an MRI). Endovascular coil embolization with parent vessel sacrifice was performed to occlude the giant aneurysm. Due to the asymptomatic nature, low risk of rupture, and the patient's age, AVM treatment was deferred.Conclusion: This paper presents the first case of a giant PICA aneurysm associated with cerebellar AVM. For PICA aneurysm-AVM complexes, meticulous evaluation of the morphology, associated anatomy, and comparative risk analysis for both lesions are key for treatment planning. Distal PICA aneurysms can be treated safely with parent vessel occlusion, particularly in the case of prenidal aneurysms.

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