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

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.

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Simultaneous Microsurgical Treatment of a Cerebellar Arteriovenous Malformation and a Distal Superior Cerebellar Artery Aneurysm

Operative Neurosurgery ◽

10.1227/neu.0000000000001141 ◽

2016 ◽

Vol 12 (3) ◽

pp. 306

Author(s):

Ali Tayebi Meybodi ◽

Arnau Benet ◽

Michael T. Lawton

Keyword(s):

Arteriovenous Malformation ◽

Artery Aneurysm ◽

Superior Cerebellar Artery ◽

Microsurgical Treatment ◽

Cerebellar Artery

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

Neurosurgery ◽

10.1093/neuros/nyw111 ◽

2017 ◽

Vol 80 (6) ◽

pp. 908-916 ◽

Cited By ~ 10

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.

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