Assuntos
Espectroscopia de Ressonância Magnética , Doença de Moyamoya/diagnóstico , Angiografia Cerebral , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Infarto Cerebral/metabolismo , Revascularização Cerebral , Criança , Feminino , Humanos , Doença de Moyamoya/metabolismo , Doença de Moyamoya/cirurgiaRESUMO
BACKGROUND: Distal aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Most of the reported cases have been located near the internal auditory meatus. Among these cases, only six located in the internal auditory meatus have been reported in the literature. METHODS: A 64-year-old female presented with sudden onset of severe headache. Computed tomography (CT) revealed moderate subarachnoid hemorrhage and Gd-DTPA enhanced magnetic resonance imaging (MRI) showed a small high-intensity mass at the right cerebellopontine angle. Although initial digital subtraction angiography (DSA) showed no vascular abnormalities, repeated DSA disclosed a saccular aneurysm at the top of the meatal loop of the right AICA. The patient underwent a suboccipital craniectomy on the 18th day after the hemorrhage RESULTS: . In this case, the aneurysm was completely buried in the internal auditory meatus. After unroofing the meatus, the aneurysm was successfully clipped. After 3 months of hospitalization, the patient was discharged with right-sided deafness, partial facial palsy, and no other complications. CONCLUSIONS: We discuss some of the clinical features and pitfalls in the surgical management of intracanalicular AICA aneurysms and review previous reports of similar cases.
Assuntos
Cerebelo/irrigação sanguínea , Aneurisma Intracraniano/diagnóstico , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Angiografia Cerebral , Circulação Cerebrovascular/fisiologia , Meios de Contraste , Diagnóstico Diferencial , Orelha Interna , Feminino , Gadolínio DTPA , Cefaleia/diagnóstico , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios X , Artéria Vertebral/cirurgiaRESUMO
A 21-year-old woman with severe mitral valve regurgitation due to infectious endocarditis was transferred to our institute in a deep coma with intracerebral hemorrhage and acute subdural hematoma. She had no history of head injury. Brain computed tomography revealed left frontoparietal intracerebral hematoma and adjacent acute subdural hematoma that were evacuated on the day of admission, but the distal middle cerebral artery (MCA) aneurysm remained undetected. Follow-up cerebral angiography demonstrated the distal MCA aneurysm, which had enlarged by 25% at 2 weeks following the first operation. The aneurysm originated from a branch of the angular artery and was successfully resected on Day 22. Histological examination of the aneurysm section showed no infectious nature, but the final diagnosis was infectious intracranial aneurysm based on the presence of infectious endocarditis.
