Endovascular Therapy for an Aneurysm of a Distal Posterior Inferior Cerebellar Artery via the Ipsilateral Persistent Primitive Proatlantal Artery: A Case Report.

Objective: We describe the rare case of a patient who was treated for a ruptured distal posterior inferior cerebellar artery (PICA) aneurysm via an ipsilateral persistent primitive proatlantal artery (PPPA). Case Presentation: An 86-year-old female with a medical history of hypertension presented with headache and nausea. CT showed subarachnoid hemorrhage in the posterior cranial fossa, and CTA revealed an aneurysm at the left-side distal PICA. In the left-sided common carotid angiography, the artery with a branch of the occipital artery from the external carotid artery was described. This artery continued as the V3 segment and entered the dura via the foramen magnum. The artery perfused the territory of the left vertebral artery and PICA. We concluded that the artery, which entered the dura, was a PPPA. We decided to perform endovascular therapy that passed through the PPPA. The aneurysm was located in the cortical segments, beyond the cranial loop. We decided that parent artery occlusion (PAO) would be more effective than selective coil embolization to achieve safe and adequate hemostasis. The patient had a good outcome with PAO not assessing collateral circulation. Conclusion: The emergency endovascular treatment with rare vascular variations requires accurate anatomical knowledge for treatment.

Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion.

BACKGROUND: A distal posterior inferior cerebellar artery (PICA) de novo aneurysm at the cortical segment after atherosclerotic basilar artery occlusion is extremely rare. Here, we report the case of a ruptured distal PICA de novo aneurysm 8 years after basilar artery occlusion. CASE DESCRIPTION: A 75-year-old man experienced sudden disturbance of consciousness; computed tomography demonstrated cerebellar and subarachnoid hemorrhage due to a ruptured distal PICA aneurysm. Neck clipping of the aneurysm prevented re-rupture initially, and superficial temporal artery-superior cerebellar artery (STA-SCA) bypass was performed 3 months after admission. Postoperative angiography confirmed patency of the bypass, and the patient was discharged without any new neurological deficits. CONCLUSION: This report describes a case of de novo development of a saccular distal PICA aneurysm after atherosclerotic basilar artery occlusion. We believe that increased hemodynamic stress at the PICA might have contributed to the occurrence and rupture of the aneurysm. STA-SCA bypass, introduced in the territory of the cerebellar hemisphere, reduces hemodynamic stress, which would prevent the occurrence of de novo aneurysm and recurrent bleeding.

Aneurysms of distal posterior inferior cerebellar artery.

OBJECTIVE: Aneurysms are very rarely encountered in the distal posterior inferior cerebellar artery (PICA). The authors experienced 5 cases with a distal PICA aneurysm among 368 cases of intracranial aneurysms during the period from January 2003 to January 2008. Here, the authors describe their clinical and surgical experiences and include a review of the relevant literature. METHODS: Using radiologic findings and charts, we retrospectively reviewed the surgical results of 5 cases with a distal PICA aneurysm treated from January 2003 to January 2008. RESULTS: The current five cases were composed of four cases of 'Good' and one case of 'Fair'. No postoperative complications occurred other than a ventriculo-peritoneal shunt due to hydrocephalus in Case 2. In all five cases, treatment was successful without neurological deficit. CONCLUSION: Surgical outcome of PICA aneurysms have been reported to be excellent because the amount of intraparenchymal injury is limited. More clinical experience, microsurgical technique developments, and endovascular surgery advancements are certain to improve treatment outcomes.

Aneurysms of Distal Posterior Inferior Cerebellar Artery

OBJECTIVE: Aneurysms are very rarely encountered in the distal posterior inferior cerebellar artery (PICA). The authors experienced 5 cases with a distal PICA aneurysm among 368 cases of intracranial aneurysms during the period from January 2003 to January 2008. Here, the authors describe their clinical and surgical experiences and include a review of the relevant literature. METHODS: Using radiologic findings and charts, we retrospectively reviewed the surgical results of 5 cases with a distal PICA aneurysm treated from January 2003 to January 2008. RESULTS: The current five cases were composed of four cases of 'Good' and one case of 'Fair'. No postoperative complications occurred other than a ventriculo-peritoneal shunt due to hydrocephalus in Case 2. In all five cases, treatment was successful without neurological deficit. CONCLUSION: Surgical outcome of PICA aneurysms have been reported to be excellent because the amount of intraparenchymal injury is limited. More clinical experience, microsurgical technique developments, and endovascular surgery advancements are certain to improve treatment outcomes.

Ruptured Aneurysm of Distal Posterior Inferior Cerebellar Artery: Report of Two Cases / 대한뇌혈관외과학회지

Aneurysms arising from the distal posterior inferior cerebellar artery (PICA) are rare. We present two cases of ruptured distal PICA aneurysms. A 48-year-old woman was admitted to our hospital because of sudden onset of severe headache and vomiting. A radiological examination revealed intraventricular hemorrhage (IVH) caused by rupture of a right distal PICA aneurysm. The aneurysm was clipped completely through a midline suboccipital approach. A 74-year-old woman was admitted to our hospital because of sudden onset of severe headache and vomiting, which was followed by unconsciousness. A radiological examination showed a hematoma in the cerebellar vermis and IVH from the fourth ventricle to the lateral ventricle with severe hydrocephalus caused by rupture of a left distal PICA aneurysm. After emergency extraventricular drainage was performed, the aneurysm was obliterated by the use of proximal parent artery clipping and coagulation. Aneurysms of the distal PICA are frequently associated with structural vascular anomalies and a high incidence of bleeding when these aneurysms are small. Thus, distal PICA aneurysms should be obliterated in almost all instances whenever they are encountered and these aneurysms should be managed immediately because of the high risk of rebleeding.