Ruptured pseudoaneurysm following Gamma Knife surgery for a vestibular schwannoma

2009 ◽  
Vol 110 (3) ◽  
pp. 543-546 ◽  
Author(s):  
Yousuke Akamatsu ◽  
Takayuki Sugawara ◽  
Shigeki Mikawa ◽  
Atsushi Saito ◽  
Sadafumi Ono ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Artery Aneurysm ◽  
Sudden Onset ◽  
Gamma Knife Surgery ◽  
Anterior Inferior Cerebellar Artery ◽  
Pathological Features ◽  
Pathological Findings ◽  
Cerebellar Artery

A 75-year-old woman underwent Gamma Knife surgery (GKS) for a vestibular schwannoma. Eight years after GKS, she suffered sudden onset of headache. Computed tomography revealed diffuse subarachnoid hemorrhage around the cisterns of the posterior fossa. Right vertebral artery angiography showed an aneurysm arising from the lateral pontomedullary segment of the left anterior inferior cerebellar artery. The aneurysm was not located at a branching site. Trapping of the distal anterior inferior cerebellar artery aneurysm was performed, and the aneurysm was removed. The pathological features of this aneurysm are discussed. This aneurysm was diagnosed as a pseudoaneurysm pathologically. This is the first report of aneurysm formation with pathological findings following GKS for a vestibular schwannoma.

De novo intracranial aneurysm formation after Gamma Knife radiosurgery for vestibular schwannoma

2009 ◽  
Vol 110 (3) ◽  
pp. 540-542 ◽  
Author(s):  
Keun Young Park ◽  
Jung Yong Ahn ◽  
Jae Whan Lee ◽  
Jong Hee Chang ◽  
Seung Kon Huh
Keyword(s):  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
De Novo ◽  
Single Case ◽  
Gamma Knife Radiosurgery ◽  
Vascular Complications ◽  
Artery Aneurysm ◽  
Anterior Inferior Cerebellar Artery ◽  
Aneurysm Formation ◽  
De Novo Aneurysm

Vascular complications, including vessel occlusion and hemorrhage, can arise after radiosurgery; however, hemorrhage due to a ruptured de novo aneurysm after Gamma Knife radiosurgery (GKS) for tumor is extremely rare. To the authors' knowledge, only a single case of de novo aneurysm formation after GKS for vestibular schwannoma has been previously reported. In this study, they describe their experience with the treatment of a 74-year-old woman with subarachnoid hemorrhage limited to the cerebellopontine cistern, who had undergone GKS for vestibular schwannoma 5 years earlier. Cerebral angiography demonstrated a left distal anterior inferior cerebellar artery aneurysm; coil embolization was attempted and failed. However, self-resolution of the aneurysm was revealed on follow-up angiography.

Intrameatal thrombosed anterior inferior cerebellar artery aneurysm mimicking a vestibular schwannoma

2011 ◽  
Vol 114 (4) ◽  
pp. 1057-1060 ◽  
Author(s):  
Dennis Päsler ◽  
Jörg Baldauf ◽  
Uwe Runge ◽  
Henry W. S. Schroeder
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Artery Aneurysm ◽  
Posterior Wall ◽  
Anterior Inferior Cerebellar Artery ◽  
Indocyanine Green Videoangiography ◽  
Cerebellar Artery ◽  
Aneurysm Resection ◽  
End To End ◽  
Acute Hearing Loss

Aneurysms of the anterior inferior cerebellar artery (AICA) are a rare entity. Purely intrameatal aneurysms are even rarer. The authors report an intrameatal thrombosed AICA aneurysm mimicking a vestibular schwannoma that was treated by resection and end-to-end anastomosis. This 22-year-old man presented with acute hearing loss, vertigo, and moderate facial palsy. Magnetic resonance imaging showed an atypical intrameatal lesion with dilation of the internal auditory canal. Microsurgical inspection via a retrosigmoid approach and drilling of the posterior wall of the internal auditory canal revealed a thrombosed AICA aneurysm. The aneurysm was excised, and an end-to-end suture was performed to restore AICA continuity. Intraoperative indocyanine green videoangiography as well as postoperative digital substraction angiography showed a good revascularization. Intrameatal AICA aneurysms may present with symptoms similar to vestibular schwannomas. End-to-end reanastomosis after aneurysm resection is a treatment option when clipping is impossible.

Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 87-97 ◽  
Author(s):  
Wen-Yuh Chung ◽  
Kang-Du Liu ◽  
Cheng-Ying Shiau ◽  
Hsiu-Mei Wu ◽  
Ling-Wei Wang ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Tumor Volume ◽  
Radiation Effect ◽  
Gamma Knife Surgery ◽  
Homogeneous Distribution ◽  
Content Type ◽  
Fine Print

Object. The authors conducted a study to determine the optimal radiation dose for vestibular schwannoma (VS) and to examine the histopathology in cases of treatment failure for better understanding of the effects of irradiation. Methods. A retrospective study was performed of 195 patients with VS; there were 113 female and 82 male patients whose mean age was 51 years (range 11–82 years). Seventy-two patients (37%) had undergone partial or total excision of their tumor prior to gamma knife surgery (GKS). The mean tumor volume was 4.1 cm3 (range 0.04–23.1 cm3). Multiisocenter dose planning placed a prescription dose of 11 to 18.2 Gy on the 50 to 94% isodose located at the tumor margin. Clinical and magnetic resonance (MR) imaging follow-up evaluations were performed every 6 months. A loss of central enhancement was demonstrated on MR imaging in 69.5% of the patients. At the latest MR imaging assessment decreased or stable tumor volume was demonstrated in 93.6% of the patients. During a median follow-up period of 31 months resection was avoided in 96.8% of cases. Uncontrolled tumor swelling was noted in five patients at 3.5, 17, 24, 33, and 62 months after GKS, respectively. Twelve of 20 patients retained serviceable hearing. Two patients experienced a temporary facial palsy. Two patients developed a new trigeminal neuralgia. There was no treatment-related death. Histopathological examination of specimens in three cases (one at 62 months after GKS) revealed a long-lasting radiation effect on vessels inside the tumor. Conclusions. Radiosurgery had a long-term radiation effect on VSs for up to 5 years. A margin 12-Gy dose with homogeneous distribution is effective in preventing tumor progression, while posing no serious threat to normal cranial nerve function.

Distal anterior inferior cerebellar artery aneurysms

2002 ◽  
Vol 97 (3) ◽  
pp. 692-696 ◽  
Author(s):  
Eric L. Zager ◽  
Ellen G. Shaver ◽  
Robert W. Hurst ◽  
Eugene S. Flamm
Keyword(s):  
Artery Aneurysm ◽  
Distal Segment ◽  
Anterior Inferior Cerebellar Artery ◽  
Management Options ◽  
Content Type ◽  
Von Hippel Lindau ◽  
Cerebellar Artery ◽  
Distal Branch ◽  
Acute Subarachnoid Hemorrhage ◽  
Fine Print

✓ Aneurysms of the distal anterior inferior cerebellar artery (AICA) are rare; fewer than 100 cases have been reported. The authors detail their experience with four cases and present endovascular as well as microsurgical management options. The medical records and neuroimaging studies obtained in four patients who were treated at a single institution were reviewed. Clinical presentations, neuroimaging and intraoperative findings, and clinical outcomes were analyzed. There were three men and one woman; their mean age was 43 years. Two patients presented with acute subarachnoid hemorrhage (SAH), and two presented with ataxia and vertigo (one with tinnitus, the other with hearing loss). Angiographic studies demonstrated aneurysms of the distal segment of the AICA. In one patient with von Hippel—Lindau syndrome and multiple cerebellar hemangioblastomas, a feeding artery aneurysm was found on a distal branch of the AICA. Three of the patients underwent successful surgical obliteration of their aneurysms, one by clipping, one by trapping, and one by resection along with the tumor. The fourth patient underwent coil embolization of the distal AICA and the aneurysm. All patients made an excellent neurological recovery. Patients with aneurysms in this location may present with typical features of an acute SAH or with symptoms referable to the cerebellopontine angle. Evaluation with computerized tomography, magnetic resonance (MR) imaging, MR angiography, and digital subtraction angiography should be performed. For lesions distal to branches coursing to the brainstem, trapping and aneurysm resection are viable options that do not require bypass. Endovascular obliteration is also a reasonable option, although the possibility of retrograde thrombosis of the AICA is a concern.

scholarly journals Endosaccular embolization for a ruptured distal anterior inferior cerebellar artery aneurysm

2012 ◽  
Vol 7 (2) ◽  
pp. 651 ◽  
Author(s):  
Hiroyuki Koizumi ◽  
Akira Kurata ◽  
Sachio Suzuki ◽  
Yoshio Miyasaka ◽  
Chihiko Tanaka ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery
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