A Case of Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysm Treated with Intra-aneurysmal Coil Embolization

✓The authors report the successful staged stenting and coil embolization of a large vertebral artery–posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm from the ipsilateral side failed, so coil embolization of the dome was performed. During a second endovascular session, the aneurysm neck was successfully stented from the contralateral VA into the PICA. Six weeks later, coils were inserted into the aneurysm from the ipsilateral side. The coil result was stable at the 3-month follow-up examination.

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Treatment of acute thrombosis during stent-assisted coil embolization of ruptured proximal posterior inferior cerebellar artery aneurysm

Brain Circulation ◽

10.4103/bc.bc_51_19 ◽

2020 ◽

Vol 6 (2) ◽

pp. 130

Author(s):

Yong Zhang ◽

Guangwen Li ◽

Tonghui Liu ◽

Naidong Wang

Keyword(s):

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Acute Thrombosis ◽

Cerebellar Artery

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Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

Interventional Neuroradiology ◽

10.1177/1591019918809087 ◽

2018 ◽

Vol 25 (2) ◽

pp. 164-171

Author(s):

George H Tse ◽

Andrew Martin ◽

Richard A Dyde ◽

Stuart C Coley

Keyword(s):

Systematic Review ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Endovascular Coiling ◽

Persistent Hypoglossal Artery ◽

Randomised Study ◽

Hypoglossal Artery ◽

Qualitative Systematic Review ◽

Cerebellar Artery ◽

Patient Reported

A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.

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Challenges in the Management of a Ruptured Bihemispheric Posterior Inferior Cerebellar Artery Aneurysm

World Neurosurgery ◽

10.1016/j.wneu.2018.11.051 ◽

2019 ◽

Vol 122 ◽

pp. 317-321 ◽

Cited By ~ 1

Author(s):

Chin Lik Tan ◽

Gopinathan Anil ◽

Tseng Tsai Yeo ◽

Ning Chou

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Cerebellar Artery

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Rupture of previously documented small asymptomatic saccular intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1992.76.6.1019 ◽

1992 ◽

Vol 76 (6) ◽

pp. 1019-1024 ◽

Cited By ~ 56

Author(s):

Wouter I. Schievink ◽

David G. Piepgras ◽

Fremont P. Wirth

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Intracranial Aneurysms ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Careful Consideration ◽

Middle Cerebral Artery Aneurysm ◽

Internal Carotid Artery Aneurysm ◽

Cerebellar Artery ◽

Cerebral Artery Aneurysm

✓ In a recent study from the Mayo Clinic on the natural history of intact saccular intracranial aneurysms, none of the aneurysms smaller than 10 mm in diameter ruptured. It was concluded that these aneurysms carry a negligible risk for future hemorrhage and that surgery for their repair could not be recommended. These findings and recommendations have been the subject of much controversy. The authors report three patients with previously documented asymptomatic intact saccular intracranial aneurysms smaller than 5 mm in diameter that subsequently ruptured. In Case 1, a 70-year-old man bled from a 4-mm middle cerebral artery aneurysm that had been discovered incidentally 2½ years previously during evaluation of cerebral ischemic symptoms. A 10-mm internal carotid artery aneurysm and a contralateral 4-mm middle cerebral artery aneurysm had not ruptured. Case 2 was that of a 66-year-old woman who bled from a 4-mm pericallosal aneurysm that had been present 9½ years previously when she suffered subarachnoid hemorrhage (SAH) from a 7 × 9-mm posterior inferior cerebellar artery aneurysm. Although the pericallosal aneurysm had not enlarged in the intervening years, a daughter aneurysm had developed. The third patient was a 45-year-old woman who bled from a 4- to 5-mm posterior inferior cerebellar artery aneurysm that had measured approximately 2 mm on an angiogram obtained 4 years previously; at that time she had suffered SAH due to rupture of a 5 × 12-mm posterior communicating artery aneurysm. These cases show that small asymptomatic intact saccular intracranial aneurysms are not innocuous and that careful consideration must be given to their surgical repair and long-term follow-up study.

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Neurosurgery (Neuro Interventional)

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.197 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S43-S44

Author(s):

JJ Shankar ◽

L Hodgson

Keyword(s):

Vertebral Artery ◽

Retrospective Analysis ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

The Third ◽

Cerebellar Artery ◽

Incomplete Coverage ◽

Negative Findings ◽

The Right

Purpose: CTA is becoming the frontline modality to reveal aneurysms in patients with SAH. However, in about 20% of SAH patients no aneurysm is found. In these cases, intra-arterial DSA is still performed. Our aim was to evaluate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. Materials and Method: We conducted a retrospective analysis of all DSA performed from August 2010 to July 2014 in patients with various indications. We selected patient who presented with SAH and had a negative CTA. Findings of the CTA were compared with DSA. Results: 857 DSA were performed during the study period. 51(5.95%) patients with SAH and negative findings on CTA who underwent subsequent DSA were identified. Of these, only 3(5.9%) of patients had positive findings on the DSA. One patient had a posterior inferior cerebellar artery aneurysm on the DSA, not seen on CTA due to the incomplete coverage of the head. Second patient’ CTA did not show any evidence of aneurysm. DSA showed suspicious dissection of the right vertebral artery, potentially iatrogenic. The third patient’s DSA showed suspicious tiny protuberance from left ICA, possibly infundibulum. Conclusion: In patients with SAH, negative CTA findings are reliable in ruling out aneurysms in any pattern of SAH on CT.

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