Tentorial edge traumatic aneurysm of the superior cerebellar artery

1997 ◽  
Vol 87 (6) ◽  
pp. 950-954 ◽  
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.

Traumatic false aneurysm of the superior cerebellar artery simulating posterior fossa tumor

1977 ◽  
Vol 46 (3) ◽  
pp. 377-380 ◽  
Author(s):  
H. Howard Cockrill ◽  
John P. Jimenez ◽  
John A. Goree
Keyword(s):  
Posterior Fossa ◽  
False Aneurysm ◽  
Superior Cerebellar Artery ◽  
Content Type ◽  
Specific Diagnosis ◽  
Cerebellar Artery ◽  
Brain Scan ◽  
The Right ◽  
Angiographic Findings ◽  
Fine Print

✓ An example of traumatic false aneurysm of the right superior cerebellar artery is described. The chronicity of the clinical picture and a positive brain scan strongly suggested a posterior fossa neoplasm; however, the angiographic findings permitted a specific diagnosis to be made.

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

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. E564-E565 ◽  
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.

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.

scholarly journals Fusiform superior cerebellar artery aneurysm treated with flow diversion: A case report

2020 ◽  
Vol 11 ◽  
pp. 330
Author(s):  
Yafell Serulle ◽  
Deepak Khatri ◽  
Jada Fletcher ◽  
Anna Pappas ◽  
Audrey Heidbreder ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Flow Diversion ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Parent Vessel ◽  
Pipeline Embolization Device ◽  
Head Ct ◽  
Cerebellar Artery ◽  
The Right

Background: Fusiform aneurysms of the distal superior cerebellar artery are rare and challenging to treat. Due to the rarity of these lesions, there is little consensus regarding their management. Treatment options have traditionally included parent artery sacrifice with either an endovascular approach or microsurgical clipping. Given the small diameter of the superior cerebellar artery, flow diversion has not been typically considered as a viable treatment option for these aneurysms. Case Description: A 67-year-old female presented complaining of severe sudden onset headache. Noncontrast head CT demonstrated no intracranial hemorrhage. Head CT angiogram demonstrated a 4.2 mm fusiform aneurysm in the distal right superior cerebellar artery. The patient underwent treatment with the Pipeline embolization device which was deployed in the right superior cerebellar artery covering the aneurysm. Six-month posttreatment follow-up angiogram demonstrated resolution of the aneurysm with patency of the parent vessel. Conclusion: To the best of our knowledge, this is the first report of a distal superior cerebellar artery aneurysm treated with the Pipeline embolization device. The use of a Pipeline stent to create flow diversion should be considered in a case of a fusiform aneurysm of the right superior cerebellar artery. Treatment with flow diversion may allow for the treatment of the aneurysm while preserving patency of the parent vessel.

Variations in location of the arteries coursing between the brain stem and the free edge of the tentorium

1992 ◽  
Vol 76 (6) ◽  
pp. 973-978 ◽  
Author(s):  
Samuil M. Blinkov ◽  
Gabib A. Gabibov ◽  
Sergei V. Tanyashin
Keyword(s):  
Brain Stem ◽  
Posterior Cerebral Artery ◽  
Free Edge ◽  
Superior Cerebellar Artery ◽  
Brain Herniation ◽  
Content Type ◽  
Cerebellar Artery ◽  
Different Types ◽  
The Brain ◽  
Fine Print

✓ The locations of arterial branches crossing the free edge of the tentorium were studied in 16 adult cadavers. Two positional variants of the superior cerebellar artery and four variants of the posterior cerebral artery were identified. The points at risk of compression by different types of transtentorial brain herniation were defined for both the arterial branches supplying the brain stem and the arterial branches supplying the cerebral hemispheres.

scholarly journals Traumatic Aneurysm of the Superior Cerebellar Artery

2007 ◽  
Vol 13 (2) ◽  
pp. 167-171 ◽  
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.

scholarly journals Thrombectomy in posterior circulation stroke through persistent primitive trigeminal artery: A case report

2015 ◽  
Vol 21 (6) ◽  
pp. 715-718 ◽  
Author(s):  
MJHL Mulder ◽  
GJ Lycklama à Nijeholt ◽  
W Dinkelaar ◽  
TPW de Rooij ◽  
ACGM van Es ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Trigeminal Artery ◽  
Left Hand ◽  
Persistent Primitive Trigeminal Artery ◽  
Cerebellar Artery ◽  
Intervention Patient ◽  
Primitive Trigeminal Artery ◽  
The Right ◽  
Neurovascular Anatomy

We describe a case of intra-arterial treatment (IAT) of acute posterior circulation occlusion in a patient with a persistent primitive trigeminal artery (PPTA). The patient presented with an acute left sided hemiparesis and loss of consciousness (Glasgow coma score of 5). Computed tomography angiography showed an acute occlusion of the right internal carotid artery (ICA), the PPTA, distal basilar artery (BA), right posterior cerebral artery (PCA), and right superior cerebellar artery (SCA). Stent-retriever assisted thrombectomy was not considered possible through the hypoplastic proximal BA. After passage of the proximal ICA occlusion, the right PCA and SCA were recanalized through the PPTA, with a single thrombectomy procedure. Ten days after intervention patient was discharged scoring optimal EMV with only a mild facial and left hand paresis remaining. PPTA is a persistent embryological carotid–basilar connection. Knowledge of existing (embryonic) variants in neurovascular anatomy is essential when planning and performing acute neurointerventional procedures.

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Cerebellar Artery ◽  
Sensory Disturbances ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
The Right ◽  
Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

scholarly journals Tentorial Incision vs. Retraction of the Tentorial Edge during the Subtemporal Approach: Anatomical Comparison in Cadaveric Dissections and Retrospective Clinical Case Series

2018 ◽  
Vol 80 (05) ◽  
pp. 441-448
Author(s):  
E. Archavlis ◽  
L. Serrano ◽  
F. Ringel ◽  
S. R. Kantelhardt
Keyword(s):  
Case Series ◽  
Free Edge ◽  
Superior Cerebellar Artery ◽  
Fast Method ◽  
Subtemporal Approach ◽  
Cerebellar Artery ◽  
Significant Difference ◽  
Suture Group ◽  
Group A ◽  
Group B

Abstract Objective The aim of this study was to compare tentorial incision (group A) versus retraction and tack up suture (group B) of the tentorial edge during the subtemporal approach for surgery in the high basilar region. Design 24 cadaveric dissections and 4 clinical cases of aneurysms of the high basilar region are presented. Assessment included visibility and operability afforded by either tentorial incision creating a dural flap (group A) or retraction of the tentorial edge and tethering with a suture (group B). Four patients, two with superior cerebellar artery aneurysms and two with proximal posterior cerebral artery aneurysms were treated with each approach. Results In the quantitative evaluations, we found no significant difference in the exposure of the posterior cerebral, superior cerebellar, and perforant arteries as well as surgical working area provided by either approach. However, tentorial incision allowed a significantly greater exposure of the basilar artery and the fourth cranial nerve (both p < 0.001). Concerning operability, tentorial incision provided no objective advantage for direct clipping of the high basilar region (groups A vs. B, p > 0.05). Subjectively, clipping of the high basilar segment was feasible using tentorial tethering only. Conclusion Retraction of the free edge of the tentorium downward by tethering with a suture is simple and fast method for exposure of aneurysms in the high basilar region when the pathology does not require a proximal control. In our data the rather more invasive and time consuming tentorial incision provided an additional objectified advantage only for placement of a proximal temporary clip.

scholarly journals Retrosigmoid Craniotomy for the Removal of Left Sided Tentorial and Posterior Fossa Meningioma Combined with Microvascular Decompression for Hemifacial Spasm

2018 ◽  
Vol 80 (S 03) ◽  
pp. S294-S295
Author(s):  
Yu-Wen Cheng ◽  
Chun-Yu Cheng ◽  
Zeeshan Qazi ◽  
Laligam N. Sekhar
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Preoperative Imaging ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Root Exit Zone ◽  
Tentorial Meningioma ◽  
Cerebellar Artery ◽  
The Right

This 68-year-old woman presented with repeated episodes of bilateral hemifacial spasm with headache for 5 years and with recent progression of left sided symptoms. Preoperative imaging showed a left sided tentorial meningioma with brain stem and cerebellar compression. Left facial nerve was compressed by the vertebral artery (VA) and the right facial nerve by the anterior inferior cerebellar artery (AICA). This patient underwent left side retrosigmoid craniotomy and mastoidectomy. The cisterna magna was drained to relax the brain. The tumor was very firm, attached to the tentorium and had medial and lateral lobules. The superior cerebellar artery was adherent to the lateral lobule of the tumor and dissected away. The tumor was detached from its tentorial base; we first removed the lateral lobule. Following this, the medial lobule was also completely dissected and removed. The root exit zone of cranial nerve (CN) VII was dissected and exposed. The compression was caused both by a prominent VA and AICA. Initially, the several pieces of Teflon felt were placed for the decompression. Then vertebropexy was performed by using 8–0 nylon suture placed through the VA media to the clival dura. A further piece of Teflon felt was placed between cerebellopontine angle region and AICA. Her hemifacial spasm resolved postoperatively, and she discharged home 1 week later. Postoperative imaging showed complete tumor removal and decompression of left CN VII. This video shows the complex surgery of microsurgical resection of a large tentorial meningioma and microvascular decompression with a vertebropexy procedure.The link to the video can be found at: https://youtu.be/N5aHN9CRJeM.

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