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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 5  |  Page : 786-788

Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar artery with parent artery preservation


Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P R, China

Date of Acceptance17-Jul-2010
Date of Web Publication28-Oct-2010

Correspondence Address:
Liu Jun
Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P R
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.72170

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How to cite this article:
Jinbo Y, Zheng Z, Jiaquan H, Hui Y, Jun L. Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar artery with parent artery preservation. Neurol India 2010;58:786-8

How to cite this URL:
Jinbo Y, Zheng Z, Jiaquan H, Hui Y, Jun L. Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar artery with parent artery preservation. Neurol India [serial online] 2010 [cited 2020 Oct 20];58:786-8. Available from: https://www.neurologyindia.com/text.asp?2010/58/5/786/72170


Sir,

Intracranial aneurysms occurring in the distal anterior inferior cerebellar artery (AICA) are rare. Most distal AICA aneurysms are treated surgically with neck clipping. Surgical treatment is difficult, particularly in patients with acute subarachnoid hemorrhage (SAH). [1] Endovascular treatment may be an alternative method. [2] However, most aneurysms of distal AICA aneurysms were embolized with parent artery occlusion. We describe here in a patient with distal AICA aneurysm successfully treated by endovascular embolization with parent artery preservation.

A 42-year-old female developed sudden onset of headache, vomiting and right ear tinnitus. On admission at five hours, she had Grade II (Hunt and Hess) SAH with right tinnitus and mild neck stiffness, Computerized tomography (CT) scan demonstrated no abnormalities [Figure 1]. Lumbar puncture indicated SAH. Digital subtraction angiography (DSA) was performed; the right vertebral angiogram revealed a saccular aneurysm (2.2-5.2 mm in size) at the right internal auditory meatal loop, fed by the right AICA [Figure 2]. Endovascular treatment was performed 9 days after admission. An Excelsior® SL-10 microcatheter was inserted into the right AICA and five GDC bare platinum coils (2 mm×4 cm, 2 mm×3 cm, 2 mm×3 cm, 2 mm×2 cm, 2 mm×2 cm) (Boston Scientific, USA) were deployed in the aneurysm sac. Postoperative vertebral angiogram revealed complete elimination of the aneurysm and satisfactory AICA patency [Figure 3]. Postoperative course was uneventful; the patient was discharged 9 days after embolization with mild right tinnitus. The clinical follow-up occurred 6 months, 12 months and 20 months after discharge. Hearing disturbance completely recovered 3 months after discharge. However, the patient refused all follow-up imaging on financial grounds
Figure 1 :Computed tomography scan taken on admission revealed no apparent abnormal findings

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Figure 2 :Right vertebral angiogram (anterior-posterior projection) reveals an aneurysm at the distal anterior inferior cerebellar artery

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Figure 3 :Right vertebral angiogram performed immediately after the embolization shows disappearance of the aneurysm with parent artery preservation

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The reported incidence of a Aneurysms of the AICA distal segment varies between are rare, with a reported incidence of 0.1 and -0.5%. [3] Since first descriptionreported by Schwartz in 1948, [4] less than <100 cases have been reported appeared in the literature. [5] Most cases of distal AICA aneurysms were treated surgically with neck clipping, trapping and wrapping. [6] However, surgical treatment of cerebellar artery aneurysms is challenging because of the deep location and adhesion to cranial nerves, particularly CVII and CVIII cranial nerves. [1] Recently, endovascular coiling with GDCs has been used to manage surgically difficult aneurysms. Endovascular treatment of vertebrobasilar artery saccular aneurysms provides more satisfactory results than direct surgery. Unfortunately, treatment of distal AICA aneurysms usually sacrifice the parent artery owning to the distance between the AICA origin and the aneurysm.

Occlusion of the proximal AICA results in syndromes related predominantly to the lateral portions of the brain stem and cerebellar peduncles. Several authors cited no ischemic complications occurring after sacrifice of the distal AICA because of sufficient collateral circulation from the ipsilateral superior cerebellar artery or posterior inferior cerebellar artery. [7] However, fine perforating vessels arising from the proximal AICA penetrate into the pons. Retrograde thrombosis due to distal occlusion of AICA may cause a devastating brain stem or cerebellar infarction. Because the aneurysm in this patient was saccular, we chose coil embolization with parent artery preservation in order to prevent ischemic complications. The aneurysm sac was confined and the minimum diameter was 2.2 mm. To ensure the safety of coil embolization, we chose the smallest and softest GDCs fitting the minimum diameter. Aneurysms of distal AICA treated endovascularly with parent artery preservation are extremely rare. To our knowledge, only three cases have been reported. [8] In our patient, no ischemic complications occurred due to preservation of the AICA.

It was the aim of this study to evaluate the feasibility of embolization of distal AICA aneurysm with parent artery preservation. Despite significant technical difficulties, good outcome was obtained in our patient. However, this strategy is not amenable to all patients as fusiform or dissecting aneurysm is still difficult to manage without sacrificing the parent artery.

 
  References Top

1.Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A. Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: A case report and review of the literature. Surg Neurol 2004;61:82-8.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP. Endovascular treatment of peripheral cerebellar artery aneurysms. AJNR Am J Neuroradiol 2003;24:1208-13.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Mizushima H, Kobayashi N, Yoshiharu S, Kazuo H, Dohi K, Sasaki K, et al. Aneurysm of the distal anterior inferior cerebellar artery at the medial branch: A case report and review of the literature. Surg Neurol 1999;52:137-42.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Schwartz HG. Arterial aneurysm of the posterior fossa. J Neurosurg 1948;5:312-6.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Zager EL, Shaver EG, Hurst RW, Flamm ES. Distal anterior inferior cerebellar artery aneurysms. Report of four cases. J Neurosurg 2002;97:692-6.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Suzuki K, Meguro K, Wada M, Fujita K, Nose T. Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar atery: Case report and review of the literature. Surg Neurol 1999;51:509-12.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Eckard DA, O'Boynick PL, Mcpherson CM, Eckard VR, Han P, Arnold P, et al. Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms. Am J Neuroradiol 2000;21:137-42.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Andreou A, Ioannidis I, Mitsos A. Endovascular treatment of peripheral intracranial aneurysms. AJNR Am J Neuroradiol 2007;28:355-61.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  


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