Embolización preoperatoria con Onyx en tumores cuya irrigación principal proviene de la arteria cerebelosa superior. Reporte de dos casos y revisión de la literatura / Preoperative embolization with Onyx in tumors whose main supply comes from the superior cerebellar artery. Report of two cases and review of the literature

Introducción : Los hemangioblastomas y los meningiomas son neoplasias intracraneales frecuentes en las cuales la resección quirúrgica total es el tratamiento indicado. En algunas situaciones, son lesiones altamente vascularizadas, por lo cual es de utilidad la embolización preoperatoria. Descripción de los casos : Caso 1: paciente mujer de 42 años de edad, que consultó por cuadro de hipertensión endocraneana y ataxia de tipo cerebeloso. Se realizó resonancia magnética, la cual mostró un proceso expansivo en la parte superior del vermis cerebeloso. La angiografía cerebral demostró un tumor muy vascularizado, a expensas de la arteria cerebelosa superior. Previo a la cirugía se realizó una embolización con Onyx. Dos días después del procedimiento endovascular, se realizó la exéresis completa del tumor. La anatomía patológica informó hemangioblastoma. Caso 2: paciente mujer de 34 años de edad, que consultó por cuadro de cefalea intensa. La resonancia magnética mostró un tumor tentorial izquierdo, con crecimiento hacia arriba. Se realizó angiografía cerebral, la cual mostró que la irrigación principal del tumor provenía de la arteria cerebelosa superior. Se realizó una embolización preoperatoria del tumor con Onyx. Tres días después del tratamiento endovascular, se realizó la exéresis completa de la lesión. La anatomía patológica informó meningioma transicional. Discusión: La recomendación de embolización preoperatoria sería en pacientes con hemangioblastomas sólidos, de gran tamaño, irrigados por vasos que no puedan ser manipulados inmediatamente durante la resección. Algo similar sucede con los meningiomas. Sin embargo, es necesario evaluar caso por caso, ya que la embolización per se implica un riesgo para el paciente. Conclusión: Cuando es necesario, se puede realizar en forma segura y efectiva la embolización con Onyx a través de la arteria cerebelosa superior, de un tumor cuya irrigación principal está dada por dicha arteria y su acceso en una etapa temprana de la cirugía es difícil.

Introduction: Hemangioblastomas and meningiomas are frequent intracranial neoplasms in which gross total resection is the indicated treatment. In some situations, they are highly vascularized lesions, and preoperative embolization is useful. Description of the cases : Case 1: a 42-year-old female patient who consulted due to intracranial hypertension and cerebellar ataxia. Magnetic resonance imaging was performed, which showed an expansive process in the upper part of the cerebellar vermis. Cerebral angiography showed a highly vascularized tumor, at the expense of the superior cerebellar artery. Prior to surgery, Onyx embolization was performed. Two days after the endovascular procedure, gross total resection of the tumor was performed. The pathology reported hemangioblastoma. Case 2: a 34-year-old female patient who consulted due to severe headache. Magnetic resonance imaging showed a left tentorial tumor, with upward growth. Cerebral angiography was performed, which showed that the main irrigation of the tumor came from the superior cerebellar artery. A preoperative embolization of the tumor with Onyx was performed. Three days after endovascular treatment, gross total resection of the tumor was performed. The pathology reported transitional meningioma. Discussion : The recommendation of preoperative embolization would be in patients with solid hemangioblastomas, irrigated by vessels that cannot be manipulated immediately during resection. Something similar happens with meningiomas. However, it is necessary to evaluate case by case, since embolization per se implies a risk for the patient. Conclusion : When necessary, embolization with Onyx, through the superior cerebellar artery, of a tumor whose main irrigation is given by that artery and tis access at an early stage of surgery is difficult, can be performed safely and effectively.

A Study Of Variations In The Origin Of Superior Cerebellar Artery And The Dimensions Of Its Proximal Segment

Background: Since many clinical conditions affecting the brain stem are the results of vascular lesions, profoundknowledge of vertebrobasilar circulation is of utmost clinical importance.Variations in the origin of superiorcerebellar artery(SCA) are frequently observed and these may play an important role in neurovascular compressionsyndrome, as III,IV and V cranial nerves are closely related to SCA. Being one of the frequent locations foraneurysms of posterior circulation,variations of SCA should be considered prior to any diagnostic or therapeuticprocedures in basilar tip region.Materials and Methods: The current study was conducted on 80 human cadaveric brain specimens to study thevariant origin of superior cerebellar artery, its anomalies, and to measure the dimensions of proximal segmentof SCA. The study was undertaken during routine dissection for the undergraduate students over a period of 5years.Results: 80 specimens, (i.e. 160 SCAs) were analysed. SCA arose from the basilar artery in 152 cases. In 3 casesSCA originated from posterior cerebral artery(PCA). SCA and PCA arose as common trunk in 5 cases.Out of 160SCAs, it arose as a single vessel in 129 cases. Duplication was seen in 28 cases. Triplication was found in 3 cases.Outer diameter of SCA at its origin was 1.8 ±0.5mm on the right side. On the left side it was 1.6 ±0.4mm.The lengthof the proximal segment of the SCA ranged from 9 to 24mm. The distance between SCA and PCA ranged from 0.6mmto 3.2mm.Conclusion: Our study identified significant variations in the origin of SCA as well as the dimensions of itsproximal segment. It would be useful for neuroradiologists in investigative procedures like CT, MRI and cerebralangiography. Neurosurgeons performing endovascular procedures for aneurysms and surgery for posteriorfossa tumors will also benefit from this study.

Contralateral Superior Cerebellar Artery Syndrome: A Consequence of Brain Herniation

Vascular compromise is a well-known consequence of brain herniation syndromes. Transtentorial brain herniation most often involves posterior cerebral arteries. However, isolated involvement of contralateral superior cerebellar artery (SCA) during unilateral impending brain herniation is reported only once and we present another case of this exceedingly rare entity. A 24-year-old man was referred to us with impending herniation due to a multiloculated hydrocephalus, and during the course of illness, he developed an isolated SCA ischemia in the opposite side of the most dilated entrapped horn. In the current article we discuss the probable pathophysiologic mechanisms of this phenomenon, as well as recommending more inclusive brain studies in cases suspected of Kernohan-Woltman notch phenomenon in unilateral brain herniation. The rationale for this commentary is that contralateral SCA transient ischemia or infarct might be the underdiagnosed underlying pathomechanism of ipsilateral hemiparesis occurring in many cases of this somehow vague phenomenon.

Unilateral Triplication of Superior Cerebellar Artery Associated with Fetal Posterior Cerebral Artery: Case Report.

Introduction: Superior cerebellar artery is the most constant among the cerebellar arteries and is almost always present, sometimes it can be double, and more rarely, triple. Methods: We report the case of a 72-yr male patient who came to hospital in whom cerebral angiography was performed because of subarachnoid hemorrhage. Results: cerebral angiography showed the unusual presence of an embryonic right posterior cerebral artery, associated with triplication of the right superior cerebellar artery. Conclusion: Th e tripling of the SCA is seen in only 7% of angiographic abnormalities and rarely is associated with posterior communicating artery aneurysms and embryonic posterior cerebral artery, as in our case.

Study of the variations of superior cerebellar artery in human cadavers.

Background: Superior Cerebellar Artery (SCA) arises just caudal to the bifurcation of basilar artery. The artery may be exposed in various neurosurgical procedures pertaining to the basilar apex, cerebellopontine angle, clivus etc. With the recent advances in neuroradiology and microvascular surgeries, the knowledge of the anatomical variations becomes very important for the neurosurgeons to perform the operations safely and successfully. Aim of current study was to study the morphometry and anatomical variations of the proximal segment of SCA (i.e. from its origin to its first bifurcation). Methods: 150 SCAs were studied by gross dissection of 75 formalin embalmed brains obtained from the department of anatomy Mysore medical college and MVJ medical college over a period of 5 years. Results: Variations like duplication in the origin was seen in 23.3%, triplication in 2% of SCAs, and abnormal origin from Posterior Cerebellar Artery (PCA) in 25.3% were noted. Other variations like tortuous course & fenestration of SCA were found. The distance from the origin of SCA to PCA ranged between 0.7-4.5 mm. The length from SCA origin to its bifurcation ranged from 6-23 mm. Outer diameter of SCA trunk at its origin varied from 1.2-2.8 mm. The outer diameter of the Basilar Artery (BA) at the basilar apex ranged between 3.2-6 mm. Conclusion: The presence of variations can alter the plan of surgical and radiological procedures. The knowledge of such variations and anomalies along with potential clinical manifestations is of paramount importance primarily for neurosurgeons and neuroradiologists.

Coil Embolization of Ruptured Thrombosed Distal Superior Cerebellar Artery Aneurysm: A Case Report

Distal thrombosed aneurysm of the superior cerebellar artery (SCA) is extremely rare and is often associated with cerebellar infarction or subarachnoid hemorrhage. We report herein on a case involving a patient with a ruptured thrombosed distal SCA aneurysm which was treated successfully through the endovascular approach.

Endovascular and Microsurgical Treatment of Superior Cerebellar Artery Aneurysms

OBJECTIVE: Superior cerebellar artery (SCA) aneurysms are regarded as being as difficult to treat surgically as posterior circulation aneurysms. We describe here a series of 33 of these aneurysms treated with microsurgery or embolization. METHODS: Between June 1997 and August 2007, 33 patients (9 men, 24 women; age, 29 to 76 years) with SCA aneurysms underwent microsurgical (n = 12) or endovascular (n = 21) treatment. Twenty two patients presented with subarachnoid hemorrhage. Thirty aneurysms were located in the junction between the SCA and the basilar artery (BA), two in the proximal SCA (S1) and one in the distal SCA (S2-3). RESULTS: Of the 29 SCA aneurysms, located in the junction between the SCA and BA, which were available on conventional angiography, 20 were lateral-superior, six lateral-horizontal, two lateral inferior, and one posterior type. Of the 12 patients treated microsurgically, eight had clinically excellent or good outcomes. Causes of poor outcomes included initial poor clinical status (n = 2), infarction due to parent artery compromise (n = 1), and artery of Heubner injury due to surgery for a coexisting anterior communicating artery aneurysm (n = 1). Of the 21 patients treated endovascularly, 17 had clinical good or excellent outcomes. Causes of clinically poor outcomes included initial poor clinical status (n = 2) and infarction due to thrombosis of exposed coil mesh (n = 1). One patient underwent embolization resulted in death due to vasospasm. Three patients required additional embolization for coil compaction. CONCLUSION: There was no morbidity related to perforator injury, regardless of the treatment modality. Embolization or microsurgery is an effective modality, with relatively low procedural morbidity and mortality rates.

Anatomical variation of the superiorcerebelar artery: a case study

During routine dissection in the laboratory was observed the presence of a variation of the superior cerebellarartery in a brain of a young adult male. This artery belongs to the vertebral-basilar system and is branch ofthe basilar artery, prior to its bifurcation giving rise to the posterior cerebral arteries. This variation is clinicallyimportant due to cerebellar infarctions that affect a significant portion of the population, and records of thistype of variation become important especially for the few records that are found in literature.

Bilateral origin of superior cerebellar arteries from the posterior cerebral arteries, and clues to its embryologic basis / 대한해부학회지

The superior cerebellar artery is the most consistent branch of the basilar artery and arises near the bifurcation of the basilar artery. A bilateral origin of the superior cerebellar arteries from the posterior cerebral arteries has been rarely reported in the literature. Reporting variations in brain vessels is important for neurosurgeons to safely and confidently treat pathologies in this region. We report on a specimen with a bilateral origin to the superior cerebellar artery from the posterior cerebral artery and discuss the embryogenesis of this rare variation.

Successful Endovascular Treatment of Ruptured Superior Cerebellar Artery Aneurysm Associated with Moyamoya Disease : A Case Report and Review of the Literature / 대한뇌혈관외과학회지

We present a patient with moyamoya disease and a ruptured superior cerebellar artery aneurysm that was managed by endovascular embolization. A 53-year-old man with sudden onset severe headache and altered mental status was referred to our hospital. Computed tomography revealed a subarachnoid hemorrhage. Cerebral angiography showed evidence of moyamoya disease and a 7 mm saccular aneurysm at the origin of the right superior cerebellar artery. Endovascular coil embolization was performed successfully without posterior cerebral artery and superior cerebellar artery obliteration. Endovascular treatment with microcoils appear particularly safe for moyamoya patients with cerebral saccular aneurysms.

Experience of Neuroendovascular Therapy for Peripheral Aneurysm of The Superior Cerebellar Artery: A Case Report / 신경중재치료의학

A case of peripheral superior cerebellar artery aneurysm was treated using neuroendovascular therapy. Not only its rarity but also some specific considerations for diagnostic and therapeutic approach of peripheral superior cerebellar artery aneurysms will be discussed herein.

Trigeminal nerve and superior cerebellar artery:An anatomic study / 中国微创外科杂志

Objective To study the relation between the trigeminal nerve and the superior cerebellar artery. Methods The authors dissected 20 cadaver skulls (40 sides):we firstly opened the calvaria and cleaned the cerebrum, then opened the tentorium of cerebellum and observed the relation between the trigeminal nerve and the superior cerebellar artery, as well as measured the distance between them, finally inspected the trend of the superior cerebellar artery. Results In the study the nearest blood vessel to the trigeminal nerve was the superior cerebellar artery, with a distance of 0～8 1 mm (mean, 2 19 mm). All the superior cerebellar arteries had rostral and caudal branches. Approximate 47 5% of the superior cerebellar arteries (19/40) crossed with trigeminal nerves, and in 87 5% of the superior cerebellar arteries (35/40) the closest site to the trigeminal nerve was the junction of the main trunk and the rostral or caudal branches. Conclusions The superior cerebella artery usually gives off rostral and caudal trunks. The junction of the main trunk and the rostral or caudal branches is nearest to the trigeminal nerve.

A Case of Aneurysm Arising from the Marginal Branch of Superior Cerebellar Artery: A Case Report

The authors present a case of non-mycotic aneurysm arising from the marginal branch of the left superior cerebellar artery(SCA) in a 65-year-old female. Cerebral angiography disclosed a saccular aneurysm(3x3 mm) at the origin of marginal branch of the left SCA. The aneurysm was successfully clipped through the infratentorial-supracerebellar approach. Since the aneurysm from the marginal branch of the SCA is rare, we reported here briefly.

Trigeminal Neuralgia Caused by Epidermoid Tumor in the Cerebellopontine Angle

The authors report two cases of trigeminal neuralgia caused by epidermoid tumor in the cerebellopontine angle. The one case showed that trigeminal nerve was displaced superiorly by the tumor and was adhesed to the superior cerebellar artery. The other case showed that tumor mass encircled the facial, acoustic nerves as well as trigeminal nerve entirely and after removal of the tumor petrosal vein was found at the root entry zone of the trigeminal nerve. Interestingly these two cases were devoid of neurologic deficit. We tried microvascular decompression as well as removal of tumor and were satisfied with its result. We reviewed the literature and discussed these cases in point of mechanisms of trigeminal neuralgia.

Intracranial Aneurysm Associated with Aplasia of the Internal Cartoid Artery

The authors report two cases of intracranial aneurysm associated with aplasia of internal carotid artery. The one case showed complete occlusion of left internal carotid artery just above the origin of ophthalmic artery and aneurysm which located at the junction of basilar-superior cerebellar artery. The blood supply of the left side of anterior cerebral came from the right carotid artery through the anterior communicating artery and the left middle cerebral artery came from basilar artery through the enlarged posterior communicating artery. The another case showed marked narrow cervical portion of right internal carotid artery which terminated as a posterior communicating artery just above the origin of ophthalmic artery and large aneurysm which located at the anterior communicating artery. The blood supply of the right side of anterior cerebral and middle cerebral artery came from the left internal carotid artery through the anterior communicating artery. We tried to surgical management of these two aneurysms. We reviewed the literature and discussed the related collateral circulation of this anomaly.