Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection. Case Report and Review of the Literature

Abstract

Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n- BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

Figure 1

Left vertebral artery injection, A-P (A) and oblique (B) projections showing two aneurysms on the inferior branch of left superior cerebellar artery.

Figure. 2

Selective angiogram - working projection before coil embolization and glue injection. Microcatheter tip placed in the sac of the aneurysm (A). Selective angiogram performed after two GDC 10 coils have been delivered shows that the parent artery is still open (B). At this point, the decision to use glue injection was made and the tip of microcatheter slightly withdrawn to gain better flow conditions.

Figure 3

Lateral X ray view after treatment,showing GDC 10 coils in the sac of the proximal aneurysm, cast of glue in the parent artery and partially in the sac of the distal aneurysm where the stasis of the contrast is seen.

Figure 4

A-B Post-treatment control angiograms of the left vertebral artery: A-P (A) and oblique (B) showing complete selective occlusion of the inferior branch of left superior cerebellar artery as well as two aneurysms.