Traumatic aneurysm at the superior cerebellar artery: illustrative case

BACKGROUND Traumatic aneurysms at the superior cerebellar arteries after head injury are extremely rare and may be overlooked. Rupture of these aneurysms can cause fatal intracranial hemorrhages; thus, early identification of the entity helps prevent detrimental outcomes. OBSERVATIONS A patient suffered from sudden severe headache and decreased consciousness level several weeks after a blunt head injury. He received surgery to remove a progressive enlarging subdural hematoma. The diagnosis of a traumatic aneurysm at the superior cerebellar artery was delayed, made only after a recurrent subdural hemorrhage occurred. He received another surgery to obliterate the aneurysm. LESSONS The patient could have been treated earlier if traumatic aneurysm had been suspected in the beginning. In addition to the case, the authors also reviewed the literature to clarify the pathophysiology, clinical presentation, diagnosis, and management of the disease.

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

Neurosurgery ◽

10.1227/00006123-199009000-00025 ◽

1990 ◽

Vol 27 (3) ◽

pp. 476-479 ◽

Cited By ~ 21

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.

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Traumatic aneurysms of the cerebral vessels

Journal of Neurosurgery ◽

10.3171/jns.1972.36.5.0531 ◽

1972 ◽

Vol 36 (5) ◽

pp. 531-536 ◽

Cited By ~ 77

Author(s):

Carlos Acosta ◽

Phillip E. Williams ◽

Kemp Clark

Keyword(s):

Head Injury ◽

Intracranial Hemorrhage ◽

Intracranial Aneurysms ◽

Cerebral Vessels ◽

Traumatic Aneurysm ◽

Content Type ◽

Traumatic Aneurysms ◽

Bleeding Episodes ◽

Fine Print

✓ Four cases of traumatic intracranial aneurysms are presented and the pathology and pathophysiology discussed. Two were successfully treated by direct surgical attack. The diagnosis of traumatic aneurysm should be suspected when a patient has an episode of intracranial hemorrhage after a head injury. The outcome of bleeding episodes is fatal in a significant number of cases. Surgery to obliterate the aneurysm is the treatment of choice.

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Acute arterial infarcts in patients with severe head injuries

Indian Journal of Neurosurgery ◽

10.4103/2277-9167.102276 ◽

2012 ◽

Vol 01 (02) ◽

pp. 126-129

Author(s):

Anil Garg ◽

Deepak Agrawal

Keyword(s):

Head Injury ◽

Severe Head Injury ◽

Head Injuries ◽

Arterial Injury ◽

Superior Cerebellar Artery ◽

Post Injury ◽

Closed Head Injuries ◽

Cerebellar Artery ◽

Ct Head ◽

The Mean

Abstract To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Patients with severe head injury (Glasgow coma score (GCS) ≤8) presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT) head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS) at 1 month post-injury or at death (whichever came earlier). Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1%) had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3–85 years). Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1–3) was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21) in patients with severe head injury without arterial infarct. A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-à-vis patient without these findings

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Superior cerebellar artery aneurysms: incidence, clinical presentation and midterm outcome of endovascular treatment

Neuroradiology ◽

10.1007/s00234-007-0251-z ◽

2007 ◽

Vol 49 (9) ◽

pp. 747-751 ◽

Cited By ~ 33

Author(s):

Jo P. P. Peluso ◽

Willem Jan van Rooij ◽

Menno Sluzewski ◽

Guus N. Beute

Keyword(s):

Endovascular Treatment ◽

Clinical Presentation ◽

Superior Cerebellar Artery ◽

Midterm Outcome ◽

Cerebellar Artery

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Tentorial edge traumatic aneurysm of the superior cerebellar artery

Journal of Neurosurgery ◽

10.3171/jns.1997.87.6.0950 ◽

1997 ◽

Vol 87 (6) ◽

pp. 950-954 ◽

Cited By ~ 15

Author(s):

François Proust ◽

Françoise Callonec ◽

Francis Bellow ◽

Annie Laquerriere ◽

Didier Hannequin ◽

...

Keyword(s):

Free Edge ◽

Pathological Examination ◽

Superior Cerebellar Artery ◽

Traumatic Aneurysm ◽

Parent Vessel ◽

Content Type ◽

Cerebellar Artery ◽

Patient’S Outcome ◽

Closed Head Trauma ◽

The Right

✓ The authors report an unusual case of a traumatic aneurysm of the right superior cerebellar artery (SCA). A 22-year-old woman presented with continuous headaches that appeared 15 days after she experienced closed head trauma as a result of a cycling accident. Computerized tomography scanning performed 3 months later showed a nodular lesion on the free edge of the tentorium, which mimicked a meningioma. The aneurysm was identified on magnetic resonance angiography, which showed the SCA as the parent vessel. The parent vessel was trapped, and the aneurysm sac was excised via right temporal craniotomy. Pathological examination of the sac revealed a false aneurysm. The patient's outcome was excellent. The pathophysiology of traumatic aneurysm at such a location suggests that surgery may be the treatment of choice.

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Traumatic Aneurysm of the Superior Cerebellar Artery

Interventional Neuroradiology ◽

10.1177/159101990701300207 ◽

2007 ◽

Vol 13 (2) ◽

pp. 167-171 ◽

Cited By ~ 4

Author(s):

Ø. Gjertsen ◽

PHJ Nakstad ◽

HKR Pedersen ◽

R. Josefsen

Keyword(s):

Subarachnoid Hemorrhage ◽

Skull Base ◽

Head Trauma ◽

Proximal Part ◽

Superior Cerebellar Artery ◽

Trauma Patients ◽

Traumatic Aneurysm ◽

Cerebellar Artery ◽

Lower Detection ◽

The Right

Following a head trauma in a 40-year-old male, massive subarachnoid hemorrhage and fractures of the skull base/clivus was found at CT. CT angiography demonstrated an aneurysm on the proximal part of the right superior cerebellar artery. The aneurysm was successfully coiled without any complication and the patient improved clinically during the following three months. The decline in use of angiography in head trauma patients during the last two decades may lead to a lower detection of traumatic aneurysm than in previous times. The value of angiographic procedures in patients suffering head traumas with SAH and skull base fractures is therefore emphasized.

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Catastrophic delayed rupture of a traumatic aneurysm of the distal superior cerebellar artery in a child

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2009.06.041 ◽

2010 ◽

Vol 17 (4) ◽

pp. 515-517 ◽

Cited By ~ 5

Author(s):

Cheng K. Ong ◽

Michelle T. Ong ◽

Dang V. Lam ◽

Jason D. Wenderoth

Keyword(s):

Superior Cerebellar Artery ◽

Traumatic Aneurysm ◽

Delayed Rupture ◽

Cerebellar Artery

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Superior Cerebellar Artery Aneurysms Causing Facial Pain: A Comprehensive Review

Operative Neurosurgery ◽

10.1093/ons/opz092 ◽

2019 ◽

Vol 18 (1) ◽

pp. 2-11

Author(s):

Javier Ros de San Pedro

Keyword(s):

Treatment Options ◽

Rare Event ◽

Outcome Data ◽

Superior Cerebellar Artery ◽

Illustrative Case ◽

Clinical Onset ◽

Female Predominance ◽

Cerebellar Artery ◽

Lateral Posterior ◽

Mean Size

Abstract BACKGROUND Trigeminal neuralgia caused by superior cerebellar artery aneurysms (TGN-SCAAs) is a rare event without previous analysis. OBJECTIVE To describe the features of TGN-SCAA based on 8 cases (7 from literature +1 illustrative case). METHODS All cases were thoroughly studied with gathering of their epidemiological, radiological, clinical, therapeutic, and outcome data. RESULTS The mean age at diagnosis was 61 yr. Gender distribution showed a female predominance (M: F = 2:6). Side distribution had a left dominance (75%). The aneurysms mean size was 15.4 mm (range: 5-27). All 5 proximal SCAAs (SCA-Basilar junction) presented a lateral-posterior projection, while all 3 distal SCAAs (s2 segment) had variable projections but constant direct trigeminal nerve (TN) contact. No hemorrhage occurred. TGN was the clinical onset in all 8 cases. The most frequent pain distribution was V1-2-3 (n = 3), followed by V1-2 (n = 1) and V1 alone (n = 1). Proximal SCAAs caused TGN through direct TN compression (n = 1), third nerve compression (n = 1), cavernous sinus compression (n = 1), or a combination thereof (n = 2). However, all distal SCAAs caused TGN by direct TN compression (n = 3). Two different treatment options were used: clipping (n = 4) and coiling (n = 4). The post-treatment Barrow Neurological Institute score for pain control was I in all cases (100%). The mRS score was 0 in 75% of cases. CONCLUSION TGN-SCAAs are infrequent lesions, characterized by large size, variable TGN mechanisms depending on their anatomic location, and mostly affecting the first and second trigeminal divisions. Both SCAA clipping and coiling were used equally, providing good neurological and pain relief results.

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