[Four cases of direct surgery for anterior inferior cerebellar artery aneurysms].

Anterior inferior cerebellar artery (AICA) aneurysms are very rare. We carried out four direct operations for AICA aneurysms including two distal AICA aneurysms using lateral suboccipital retrosigmoid approaches (LSRA). We successfully performed the clipping by LSRA. but hearing loss occurred except in one of our cases which involved a chronic term operation in in our cases, In a 72 years old female with a ruptured dissecting aneurysm of the AICA anterior pontine segment, we performed the OA-PICA anastomosis first because of its being an AICA-PICA type, and then we continued to carry out the trapping operation of dissecting artery on day 0. She left our hospital cheerfully but hearing loss persisted on the operated side. Four examples of the dissecting aneurysm of AICA anterior pontine segment have been reported, but only our case involved the trapping with revascularization in acute stage. At the moment, there is no clinical or useful classification for distal AICA aneurysm because it is extremely rare. We will now propose a new classification. This classification is divided into two groups, (1) P (pons) -group and (2) C (cerebellum) -group. The P-group consists of pA (AICA anterior pontine segment). pL (lateral branch on the pons to the meatal loop) and pM (medial branch on the pons). C-group consists of m-loop (meatal loop), cL (lateral branch post meatal loop) and cM (medial branch on the cerebellum). From results of case reports (75 distal AICA aneurysms), we found that pA: 5 (6.7%), pL: 2 (2.8%), pM: 0, m-loop: 54 (72%), cL: 8 (11%), cM: 6 (8.3%). The followings factors were also found. (1) Occlusion of the parent artery of P-group without revascularization of peripheral circulation may entail the risk of death. (2) On the other hand, as for the C-group, the parent artery was able to be occluded without severe consequences, but hearing loss and/or cerebellar infarction occurred. We believe that this classification is simple and very useful for therapeutic strategies in both direct surgery and intravascular treatments for distal AICA aneurysms.

[Seven cases of posterior cerebral artery aneurysms].

In a period of ten years, since January 1996, we have encountered seven cases of posterior cerebral artery aneurysms (0.58% of surgically treated 1027 aneurysms in our hospital). Six of these cases were females (from 39 years old to 73 years old, average 54.5 years old). In five of the cases, neck clippings were performed, using the pterional approach for one P1 and one P2a aneurysm, the remaining three were clipping using the subtemporal approach for one P2a and two P2p aneurysms. In one case diagnosed as "unknown SAH" by typical findings of the CT scan and normal four-vessel study at the time of admission. The second vertebral angiography (two weeks later) revealed a P2a aneurysm. Such a case attracted our interest in the clinic, because many similar cases might have been diagnosed as "unknown SAH". In the case of a 42-year-old male with intracerebral hematoma, four-vessel study made a definite diagnosis as moyamoya disease and revealed a P2a aneurysm, which we cured by embolization of GDC for the preservation of anastomosis networks which had already been formed. Intravascular embolization is very effective, but sufficient studies are required before applying it in the cases of large and/or thrombosed aneurysms. We described surgical approaches about pterional, subtemporal and transchoroidal approaches and discussed some of the differences in the classification methods of Pia, Yasargil, Zear & Rhoton and Seoane. In particular, attention is necessary because we have confused Yasargil's classification with Zeal & Rhoton's classifications by using of the same notation, "Pn".