Treatment and Outcome of Anterior Inferior Cerebellar Artery (AICA) Aneurysms: Helsinki Series of 15 Consecutive Patients.

Abstract Background: Anterior inferior cerebellar artery (AICA) aneurysms are rare posterior circulation lesions that are challenging to treat.Objectives: To present the treatment and clinical outcome of AICA aneurysms in an unselected cohort of patients.Methods: A retrospective analysis of patient record files, DSA and CT angiography images of 15 consecutive patients harboring AICA aneurysms treated between 1968 to 2017. Results: Eighty percent of the AICA aneurysm patients were females. Twenty percent presented with intracerebral hemorrhage (ICH) and 40% had intraventricular hemorrhage. Eleven (73%) patients suffered from subarachnoid hemorrhage (SAH); a good-grade SAH (Hunt and Hess grade 1-3) was observed in 82 % SAH patients. Surgery was performed in 73 % patients. Coil embolization was done in 7% patients and 20 % patients were treated conservatively. In 73 % patients retrosigmoid approach was used and in 27 % patients a sub-temporal approach with anterior petrosectomy was applied. A parent vessel occlusion was needed to occlude the aneurysm in 18 % patients.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. Surgical treatment may be an option only in selected cases of AICA aneurysms.

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Republished: Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011736.rep ◽

2015 ◽

Vol 8 (5) ◽

pp. e19-e19 ◽

Cited By ~ 8

Author(s):

Justin R Mascitelli ◽

Ian T McNeill ◽

J Mocco ◽

Alejandro Berenstein ◽

Joseph DeMattia ◽

...

Keyword(s):

Effective Treatment ◽

Vestibular Schwannoma ◽

Rare Complication ◽

Anterior Inferior Cerebellar Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Neurological Exam ◽

Parent Vessel Occlusion ◽

History Of

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.

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Successful Endovascular Management of Intra-meatal Anterior Inferior Cerebellar Artery–Posterior Inferior Cerebellar Artery Variant Aneurysm

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0038-1642107 ◽

2018 ◽

Vol 02 (01) ◽

pp. 059-061

Author(s):

Vikram Bohra ◽

Romnesh DeSouza ◽

Vikram Huded

Keyword(s):

Surgical Management ◽

Case Reports ◽

Posterior Inferior Cerebellar Artery ◽

Common Trunk ◽

Anterior Inferior Cerebellar Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Unsuccessful Attempt ◽

Cerebellar Artery ◽

Parent Vessel Occlusion

AbstractAnterior inferior cerebellar artery–posterior inferior cerebellar artery (AICA-PICA) variant or common trunk is seen frequently in vertebral angiograms as PICA is found to be hypoplastic or absent in approximately 20 to 25% of patients. There have been very few case reports of aneurysm arising in AICA-PICA variant. Intrameatal AICA aneurysms are also rare, with no reports involving AICA-PICA variant till date. Neurosurgical approach and clipping have been proposed as first-line treatment option for intrameatal AICA aneurysms. The authors report a case of a young woman presenting with subarachnoid hemorrhage, found to have a right AICA-PICA variant aneurysm in intrameatal location. The patient underwent coiling with parent vessel occlusion after an unsuccessful attempt at surgical management of the same. She recovered without any postprocedure complication. This case report highlights the fact that endovascular approach can be used to manage distal AICA/AICA-PICA variant or intrameatal aneurysm with added advantage of avoiding the postprocedure complications associated with surgical management of the same.

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Routine intraoperative angiography during aneurysm surgery

Journal of Neurosurgery ◽

10.3171/jns.2002.96.6.0988 ◽

2002 ◽

Vol 96 (6) ◽

pp. 988-992 ◽

Cited By ~ 134

Author(s):

Veronica L. Chiang ◽

Phillipe Gailloud ◽

Kieran J. Murphy ◽

Daniele Rigamonti ◽

Rafael J. Tamargo

Keyword(s):

Surgical Treatment ◽

False Negative ◽

Anterior Communicating Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Intraoperative Angiography ◽

Content Type ◽

Negative Results ◽

Parent Vessel Occlusion ◽

Fine Print

Object. The routine use of intraoperative angiography as an aid in the surgical treatment of aneurysms is uncommon. The advantages of the ability to visualize residual aneurysm or unintended occlusion of parent vessels intraoperatively must be weighed against the complications associated with repeated angiography and prolonged vascular access. The authors reviewed the results of their routine use of intraoperative angiography to determine its safety and efficacy. Methods. Prospectively gathered data from all aneurysm cases treated surgically between January 1996 and June 2000 were reviewed. A total of 303 operations were performed in 284 patients with aneurysms; 24 patients also underwent postoperative angiography. Findings on intraoperative angiographic studies prompted reexploration and clip readjustment in 37 (11%) of the 337 aneurysms clipped. Angiography revealed parent vessel occlusion in 10 cases (3%), residual aneurysm in 22 cases (6.5%), and both residual lesion and parent vessel occlusion in five cases (1.5%). When compared with subsequent postoperative imaging, false-negative results were found on two intraoperative angiograms (8.3%) and a false-positive result was found on one (4.2%). Postoperative angiograms obtained in both false-negative cases revealed residual anterior communicating artery aneurysms. Both of these aneurysms also subsequently rebled, requiring reoperation. In the group that underwent intraoperative angiography, in 303 operations eight patients (2.6%) suffered complications, of which only one was neurological. Conclusions. In the surgical treatment of intracranial aneurysms, the use of routine intraoperative angiography is safe and helpful in a significant number of cases, although it does not replace careful intraoperative inspection of the surgical field.

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GIANT FUSIFORM ANEURYSM ARISING FROM FENESTRATED POSTERIOR CEREBRAL ARTERY AND BASILAR TIP VARIATION

Neurosurgery ◽

10.1227/01.neu.0000338431.70709.81 ◽

2009 ◽

Vol 64 (3) ◽

pp. E564-E565 ◽

Cited By ~ 6

Author(s):

Marco A. Zanini ◽

Vitor M. Pereira ◽

Mauricio Jory ◽

José G.M.P. Caldas

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Superior Cerebellar Artery ◽

Fusiform Aneurysm ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Parent Vessel Occlusion ◽

The Right ◽

Double Origin

Abstract OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1–P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin. CLINICAL PRESENTATION A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1–P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin. INTERVENTION Surgical trapping of the right P1–P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life. CONCLUSION To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1–P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

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Distal Parent Vessel Occlusion of 2 Superior Cerebellar Artery Fusiform Aneurysms: Report of 2 Cases and Literature Review

World Neurosurgery X ◽

10.1016/j.wnsx.2019.100026 ◽

2019 ◽

Vol 3 ◽

pp. 100026

Author(s):

Luis C. Ascanio ◽

Christopher S. Ogilvy ◽

Ajith J. Thomas ◽

Kimberly Kicielinski ◽

Raghav Gupta ◽

...

Keyword(s):

Literature Review ◽

Superior Cerebellar Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Parent Vessel Occlusion

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Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization

Journal of Neurosurgery ◽

10.3171/jns.1995.83.5.0843 ◽

1995 ◽

Vol 83 (5) ◽

pp. 843-853 ◽

Cited By ~ 139

Author(s):

John H. Gurian ◽

Neil A. Martin ◽

Wesley A. King ◽

Gary R. Duckwiler ◽

Guido Guglielmi ◽

...

Keyword(s):

Surgical Treatment ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Parent Vessel ◽

Vessel Occlusion ◽

Content Type ◽

Neurological Improvement ◽

Parent Vessel Occlusion ◽

Group B

✓ Modern endovascular techniques permit treatment of intracranial aneurysms in many circumstances when surgery is associated with significant morbidity. Occasionally, embolization of aneurysms is unsuccessful or incomplete or followed by complications, in which case surgical management is required. Since 1986, 196 patients have undergone embolization of intracranial aneurysms at the authors' institution and 21 (11%) required subsequent surgical treatment. Attempted embolization failed in five patients (Group A). Ten patients (Group B) had only partial occlusion of the aneurysm or demonstrated recanalization on follow-up studies. Eight of these Group B patients underwent embolization with Guglielmi detachable coils (GDCs), representing 5.7% of the 141 GDC-treated patients in this experience. Surgical treatment in these two groups consisted of clipping (eight cases), surgical parent vessel occlusion (one case), and parent vessel occlusion with extracranial—intracranial bypass (six cases). Fourteen (93%) of the 15 patients in these two groups had an excellent or good outcome with complete aneurysm occlusion. Six patients underwent surgery to treat complications related to the endovascular procedure (Group C). Of these, four patients had neurological improvement compared to their preoperative state, and two died. This series of cases demonstrates that surgical treatment of aneurysms is usually possible with good results following incomplete embolization and emphasizes the need for close and continued neurosurgical involvement in the endovascular management of intracranial aneurysms.

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Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion

Neuroradiology ◽

10.1007/s00234-007-0333-y ◽

2007 ◽

Vol 50 (4) ◽

pp. 315-320 ◽

Cited By ~ 33

Author(s):

Martino Cellerini ◽

Salvatore Mangiafico ◽

Franco Ammannati ◽

Gennaro Ambrosanio ◽

Mario Muto ◽

...

Keyword(s):

Endovascular Treatment ◽

Posterior Inferior Cerebellar Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Parent Vessel Occlusion

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Traumatic dissecting pathology of posterior cerebral artery: a report of two cases—aneurysm and pial arteriovenous fistula

BMJ Case Reports ◽

10.1136/bcr-2020-237722 ◽

2021 ◽

Vol 14 (5) ◽

pp. e237722

Author(s):

Vignesh Selvamurugan ◽

Surya Nandan Prasad ◽

Vivek Singh ◽

Zafar Neyaz

Keyword(s):

Arteriovenous Fistula ◽

Cerebral Artery ◽

Road Traffic ◽

Posterior Cerebral Artery ◽

Case Reports ◽

Dissecting Aneurysm ◽

Parent Vessel ◽

Vessel Occlusion ◽

Parent Vessel Occlusion ◽

Pial Arteriovenous Fistula

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Both the patients underwent endovascular treatment: stent-assisted coiling for aneurysm and coiling with parent vessel occlusion for PAVF. There were no procedural complications. Follow-up angiography showed no residual aneurysm or fistula. Trauma is one of the recognised causes of dissection, and intracranial dissections can present as stenotic lesions, aneurysms or fistulas, depending on the pathology. Traumatic dissecting PCA aneurysm has been reported in only two case reports previously, and post-traumatic PAVF in PCA has not been reported.

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Flow diversion in the treatment of aneurysms: a randomized care trial and registry

Journal of Neurosurgery ◽

10.3171/2016.4.jns152662 ◽

2017 ◽

Vol 127 (3) ◽

pp. 454-462 ◽

Cited By ~ 34

Author(s):

Jean Raymond ◽

Jean-Christophe Gentric ◽

Tim E. Darsaut ◽

Daniela Iancu ◽

Miguel Chagnon ◽

...

Keyword(s):

Standard Treatment ◽

Flow Diversion ◽

Parent Vessel ◽

Management Options ◽

Vessel Occlusion ◽

Clinical Trial Registration ◽

Safety Outcome ◽

Standard Management ◽

Efficacy Outcome ◽

Parent Vessel Occlusion

OBJECTIVEThe Flow Diversion in the Treatment of Intracranial Aneurysm Trial (FIAT) was designed to guide the clinical use of flow diversion, an innovative method to treat intracranial aneurysms, within a care trial and to study safety and efficacy.METHODSFIAT, conducted in 3 Canadian hospitals, proposed randomized allocation to flow diversion or standard management options (observation, coil embolization, parent vessel occlusion, or clip placement), and a registry of non-randomized patients treated with flow diversion. The primary safety outcome was death or dependency (modified Rankin Scale score > 2) at 3 months, to be determined for all patients who received flow diversion at any time. The primary efficacy outcome was angiographic occlusion at 3–12 months combined with an independent clinical outcome.RESULTSOf 112 participating patients recruited between May 2, 2011, and February 25, 2015, 78 were randomized (39 in each arm), and 34 received flow diversion within the registry. The study was halted due to safety concerns. Twelve (16%) of 75 patients (95% CI 8.9%–26.7%) who were allocated to or received flow diversion at any time were dead (n = 8) or dependent (n = 4) at 3 months or more, crossing a predefined safety boundary. Death or dependency occurred in 5 (13.2%) of 38 patients randomly allocated and treated by flow diversion (95% CI 5.0%–28.9%) and in 5 (12.8%) of 39 patients allocated to standard treatment (95% CI 4.8%–28.2%). Efficacy was below expectations of the trial hypothesis: 16 (42.1%) of 38 patients (95% CI 26.7%–59.1%) randomly allocated to flow diversion failed to reach the primary outcome, as compared with 14 (35.9%) of 39 patients allocated to standard treatment (95% CI 21.7%–52.9%).CONCLUSIONSFlow diversion was not as safe and effective as hypothesized. More randomized trials are needed to determine the role of flow diversion in the management of aneurysms.Clinical trial registration no.: NCT01349582 (clinicaltrials.gov)

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