An additional MRI confirmed the suspected location and gigantic size of the partially thrombosed lesion, and the patient was prepared for surgery. Following catheter placement and 3 Dimensional-Digital Subtraction Angiography imaging, an aneurysm on the peripheral branch of the SCA was found, which was inaccessible for endovascular treatment due to the luminal diameter of the vessel. Following atypical angiography findings, an aneurysm on the bifurcation of the basilar artery (BA) was suspected ( Figure 1), and the patient was urgently referred for endovascular treatment. Computed tomography (CT) confirmed Fischer grade 2 subarachnoid hemorrhage (SAH). SCA AneurysmĪ 57-year-old female hypertonic patient was admitted to the neurology unit of a regional hospital in a mild Hunt and Hess grade for sudden-onset headache and vomiting. The management reflects current trends, with microsurgical clipping, endovascular treatment, or a combination of both simultaneous revascularization is indicated in exceptional cases. AICA aneurysms had the highest percentage of distal location. Distal PICA aneurysms were the most common distal aneurysm on cerebellar arteries. The incidence of distal aneurysms on cerebellar arteries was 4.3 times greater than that of distal aneurysms on cerebral arteries, indicating a predilection of distal aneurysms for posterior circulation. The largest study of distal PICA aneurysms (30) was published by Tokimura, while Hernandez focused on distal aneurysms of all intracranial arteries with predilection for cerebellar arteries. In the most comprehensive study of aneurysms of the posterior cerebral circulation published so far, three distal aneurysms on the peripheral SCA were reported feeding a malformation, with 13 distal aneurysms on the PICA and a mere four distal aneurysms on the AICA. Merely anecdotal cases, limited cohorts, or numeric mentions within large groups dealing with the involvement of posterior cerebral circulation are reported. While involvement of the posterior inferior cerebellar artery (PICA) in an aneurysm on the proximal segment is a common feature of aneurysms (up to 6% of all intracranial aneurysms), for involvement of the distal segment, the above-mentioned limitations must be applied. Similar limitations in occurrence may be applied to anterior inferior cerebellar artery (AICA) aneurysms, which are mentioned in the literature usually because of their marked symptomatology determined by a close anatomical relationship with the internal auditory meatus and cerebellopontine angle segments. They occur as a result of both mycotic disease and complex dysplasia along with arteriovenous malformation (AVM), or they may accompany malforming angiitis in systemic diseases only rarely do they occur alone. In three patients, the associated AVM was treated (two with microsurgery, one with embolization).Īneurysms arising from the superior cerebellar artery (SCA) are very rare, accounting for only 0.3% to 0.7% of all intracranial aneurysms. (4) Conclusion: The authors present their experience with the treatment of 11 peripheral aneurysms on distal branches of the cerebellar circulation in seven patients which were excluded from circulation by microsurgery or endovascular treatment. Clinical follow-up was a mean of 11.5 months (range, 3–45 months). Two aneurysms were treated by endovascular coiling, and one associated AVM was successfully embolized. (3) Results: Nine aneurysms were treated by microsurgery trapping or clipping and, in two patients, the associated arteriovenous malformation (AVM) was resected. One patient had three aneurysms, and two patients had two aneurysms. Aneurysm location was the posterior inferior cerebellar artery in six cases, the superior cerebellar artery in three cases, and the anterior inferior cerebellar artery in 2 cases. Five patients presented with different grades of subarachnoid hemorrhage or intraventricular bleeding, and two patients were diagnosed because of headache. There were four women and three men, ranging from 50 to 72 years of age. Eleven aneurysms in seven patients were located on distal cerebellar arteries and, in three patients, the aneurysms were combined with arteriovenous malformations.
#Aica vs pica syndrome series
The authors report their case series of distal aneurysms of the cerebellar arteries solved successfully by microsurgery or by endovascular treatment (Table 1) (2) Materials and Methods: Between January 2010 and March 2020, 346 aneurysms were treated in our institution. (1) Background: Distal aneurysms of cerebellar arteries are very rare.
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