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anterior_inferior_cerebellar_artery_aneurysm

Anterior inferior cerebellar artery aneurysm

Aneurysms of the anterior inferior cerebellar artery (AICA) are relatively rare among intracranial aneurysms. They can occur in 1 of 3 regions of the AICA:

1) craniocaudal (high or low riding)

2) mediolateral-premeatal (proximal)

3) meatal-postmeatal (distal).

Treatment

The management strategies for treatment differ according to the location and configuration of the aneurysm. The existing body of neurosurgical literature contains articles published on aneurysms arising from the AICA near the basilar artery (BA), intracanalicular/meatal aneurysms, and distal AICA. Several therapeutic options exist, encompassing microsurgical and endovascular techniques.

Bambakidis et al. describe a case of treatment involving a large BA-AICA aneurysm approached via exposure of the presigmoid dura using a retromastoid suboccipital craniectomy and partial petrosectomy. Treatment of these lesions requires detailed knowledge of the anatomy, and an anatomical overview of the AICA with its arterial loops and significant branches is presented, including a discussion of the internal auditory artery, recurrent perforating arteries, subarcuate artery, and cerebellosubarcuate artery. The authors discuss the various surgical approaches (retromastoid, far lateral, subtemporal, and transclival) with appropriate illustrations, citing the advantages and disadvantages in accessing these AICA lesions in relation to these approaches. The complications of these different surgical techniques and possible clinical effects of parent artery occlusion during AICA surgery are highlighted. 1)

Aneurysms arising from the midbasilar trunk are not common, and surgical management of these aneurysms remains a difficult challenge to neurosurgeons because of its anatomic characteristics. A patient with a ruptured aneurysm arising from the basilar artery at the origin of the anterior inferior cerebellar artery and projecting to the right and upward. The aneurysm was successfully treated by a subtemporal transpetrosal approach in an acute stage 2).

Subtemporal Approach for AICA Aneurysm Clipping

3).

Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA) 4).

Videos

Far-lateral transcondylar approach for microsurgical trapping of an anterior inferior cerebellar artery aneurysm

Case reports

2017

Sato S, Adachi H, Imamura H, Sakai N, Tani S, Narumi O, Sakai C, Arimura K, Morimoto T, Shibata T, Agawa Y, Shimizu K, Kikuchi H. [A Case of Stent-Assisted Coil Embolization for Ruptured Anterior Inferior Cerebellar Aneurysm after Iatrogenic Vertebral Arteriovenous Fistula]. No Shinkei Geka. 2017 Nov;45(11):997-1002. doi: 10.11477/mf.1436203635. Japanese. PubMed PMID: 29172206 5).

1)
Bambakidis NC, Manjila S, Dashti S, Tarr R, Megerian CA. Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature. Neurosurg Focus. 2009 May;26(5):E6. doi: 10.3171/2009.1.FOCUS0915. Review. PubMed PMID: 19409007.
2)
Inoue Y, Mikami J, Omiya N, Okawara S. Subtemporal transpetrosal approach to ruptured midbasilar trunk aneurysm. Skull Base Surg. 1992;2(2):98-102. PubMed PMID: 17170849; PubMed Central PMCID: PMC1656342.
3)
Abla AA, Ivan ME, Lawton MT. Subtemporal-medial transpetrous (kawase) approach for anterior inferior cerebellar artery aneurysm clipping: operative 3-dimensional video. Neurosurgery. 2014 Sep;10 Suppl 3:488-9. doi: 10.1227/NEU.0000000000000440. PubMed PMID: 24871145.
4)
Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. J Neurointerv Surg. 2015 May 11. pii: neurintsurg-2015-011736.rep. doi: 10.1136/neurintsurg-2015-011736.rep. [Epub ahead of print] PubMed PMID: 25964373.
5)
Sato S, Adachi H, Imamura H, Sakai N, Tani S, Narumi O, Sakai C, Arimura K, Morimoto T, Shibata T, Agawa Y, Shimizu K, Kikuchi H. [A Case of Stent-Assisted Coil Embolization for Ruptured Anterior Inferior Cerebellar Aneurysm after Iatrogenic Vertebral Arteriovenous Fistula]. No Shinkei Geka. 2017 Nov;45(11):997-1002. doi: 10.11477/mf.1436203635. Japanese. PubMed PMID: 29172206.
anterior_inferior_cerebellar_artery_aneurysm.txt · Last modified: 2017/11/27 08:10 by administrador