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Case Reports
. 2016 Dec 21;7(Suppl 41):S1065-S1068.
doi: 10.4103/2152-7806.196377. eCollection 2016.

Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion

Akiko Marutani  1 , Ichiro Nakagawa  1 , Hun Soo Park  1 , Kentaro Tamura  1 , Yasushi Motoyama  1 , Hiroyuki Nakase  1
Affiliations
Case Reports

Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion

Akiko Marutani et al. Surg Neurol Int. .

Abstract

Background: A distal posterior inferior cerebellar artery (PICA) de novo aneurysm at the cortical segment after atherosclerotic basilar artery occlusion is extremely rare. Here, we report the case of a ruptured distal PICA de novo aneurysm 8 years after basilar artery occlusion.

Case description: A 75-year-old man experienced sudden disturbance of consciousness; computed tomography demonstrated cerebellar and subarachnoid hemorrhage due to a ruptured distal PICA aneurysm. Neck clipping of the aneurysm prevented re-rupture initially, and superficial temporal artery-superior cerebellar artery (STA-SCA) bypass was performed 3 months after admission. Postoperative angiography confirmed patency of the bypass, and the patient was discharged without any new neurological deficits.

Conclusion: This report describes a case of de novo development of a saccular distal PICA aneurysm after atherosclerotic basilar artery occlusion. We believe that increased hemodynamic stress at the PICA might have contributed to the occurrence and rupture of the aneurysm. STA-SCA bypass, introduced in the territory of the cerebellar hemisphere, reduces hemodynamic stress, which would prevent the occurrence of de novo aneurysm and recurrent bleeding.

Keywords: Distal posterior inferior cerebellar artery aneurysm; hemodynamic stress; neck clipping; superficial temporal artery-superior cerebellar artery bypass.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A diffusion-weighted image showing left brainstem infarction (a). Brain computed tomography images showing right cerebellar hemorrhage, subdural hemorrhage, subarachnoid hemorrhage of the posterior cranial fossa, and intraventricular hemorrhage (b, c)
Figure 2
Figure 2
Three-dimensional digital subtraction angiography images showing basilar artery occlusion and a 3.6-mm saccular aneurysm at the cortical segment of the left distal posterior inferior cerebellar artery. (a) anteroposterior view, (b) lateral view
Figure 3
Figure 3
Intraoperative images showing the ruptured distal posterior inferior cerebellar artery aneurysm (a) and neck clipping of the aneurysm (b). Indocyanine green videoangiography showing complete neck clipping (c)
Figure 4
Figure 4
Intraoperative images showing right superficial temporal artery-superior cerebellar artery (STA-SCA) bypass. (a) preparation of the SCA branch, (b) end-to side anastomosis. Indocyanine green videoangiography demonstrating bypass patency (c)
Figure 5
Figure 5
Postoperative digital subtraction angiography performed a month after bypass surgery. Right external cerebral angiography showing the establishment of new blood vessels from the right superior cerebellar artery to the left superior cerebellar artery (a), and right common carotid angiography showing bilateral posterior cerebral arteries via the posterior communicating artery (b)
Figure 6
Figure 6
Single photon emission computed tomography images at rest showing improvement of cerebellar and occipital blood flow (mL/100 g/min) before (a) and 3 months after (b) bypass surgery
See this image and copyright information in PMC

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