J Neurol Surg A Cent Eur Neurosurg 2012; 73(05): 267-274
DOI: 10.1055/s-0032-1304213
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Strategies in the Treatment of Distal Cerebellar Aneurysms: Report of a Series of 11 Patients

Ali Harati
1   Department of Neurosurgery, Klinikum Vest, Recklinghausen, Germany
,
Anastasios Mpotsaris
2   Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany
,
Frauke Lohmann
1   Department of Neurosurgery, Klinikum Vest, Recklinghausen, Germany
,
Christian Loehr
2   Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany
,
Werner Weber
2   Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany
,
Maximilian J. A. Puchner
1   Department of Neurosurgery, Klinikum Vest, Recklinghausen, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

25. März 2011

19. Oktober 2011

Publikationsdatum:
14. Mai 2012 (online)

Abstract

Background Distal cerebellar artery aneurysms are rare entities and treatment modalities technically challenging. In recent years, new therapeutic options have emerged through microsurgical and endovascular means.

Objective Based on a series of 11 cases, we describe combined interdisciplinary treatment strategies and report the outcome in a midterm follow-up interval of 12 months.

Methods Collection of clinical case data during acute phase and follow-up including standardized angiographic control intervals during follow-up and assessment of the outcome.

Results 7 of 11 reported cases had flow-related aneurysms based on an underlying arteriovenous malformation (AVM) or dural arteriovenous fistula (DAVF); we found multiple aneurysms in four cases. All patients with flow-related aneurysms presented with subarachnoid hemorrhage (SAH). Only one of four patients in this series without an underlying AVM or DAVF presented with SAH that was attributable to a distal cerebellar aneurysm. In one case, we observed a de novo formation of two flow-associated distal aneurysms (10 years interval). Two patients were treated conservatively, five patients were treated endovascularly, one patient was treated surgically and three patients were treated with combined methods. 9 of 11 patients with initial SAH had a good outcome.

Conclusions Distal cerebellar aneurysms associated with AVM or DAVF are rare but characterized by a high risk of hemorrhage. The present series indicates that an experienced interdisciplinary team and the combination of available techniques may lead to a reduction of complications and to a better outcome.

 
  • References

  • 1 Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 1966; 25 (2) 219-239
  • 2 Weber W, Kis B, Siekmann R, Jans P, Laumer R, Kühne D. Preoperative embolization of intracranial arteriovenous malformations with Onyx. Neurosurgery 2007; 61 (2) 244-252 , discussion 252–254
  • 3 Hudgins RJ, Day AL, Quisling RG, Rhoton Jr AL, Sypert GW, Garcia-Bengochea F. Aneurysms of the posterior inferior cerebellar artery. A clinical and anatomical analysis. J Neurosurg 1983; 58 (3) 381-387
  • 4 Salcman M, Rigamonti D, Numaguchi Y, Sadato N. Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex: variations on a theme. Neurosurgery 1990; 27 (1) 12-20 , discussion 20–21
  • 5 Yoshimoto T, Kodama N, Fujita K. Distribution of intracranial aneurysms. In: Suzuki J, (ed.) Cerebral Aneurysms. Tokyo: Neuron; 1979: 14-19
  • 6 Suzuki J, Hori S, Sakurai Y. Intracranial aneurysms in the neurosurgical clinics in Japan. J Neurosurg 1971; 35 (1) 34-39
  • 7 Gács G, Viñuela F, Fox AJ, Drake CG. Peripheral aneurysms of the cerebellar arteries. Review of 16 cases. J Neurosurg 1983; 58 (1) 63-68
  • 8 Fuwa I, Matsukado Y, Kaku M, Nonaka S. Enlargement of a cerebral aneurysm associated with ruptured arteriovenous malformation. Acta Neurochir (Wien) 1986; 80 (1-2) 65-68
  • 9 Azzam CJ. Growth of multiple peripheral high flow aneurysms of the posterior inferior cerebellar artery associated with a cerebellar arteriovenous malformation. Neurosurgery 1987; 21 (6) 934-939
  • 10 Fry DL. Acute vascular endothelial changes associated with increased blood velocity gradients. Circ Res 1968; 22 (2) 165-197
  • 11 Binggeli RS, Schroth G, Steiger HJ. Distal aneurysm of the rostral duplicate anterior inferior cerebellar artery feeding an associated dural arteriovenous malformation: case report and review of the literature. J Clin Neurosci 1998; 5 (2) 237-244
  • 12 Drake CG. The treatment of aneurysms of the posterior circulation. Clin Neurosurg 1979; 26: 96-144
  • 13 Kim EJ, Halim AX, Dowd CF , et al. The relationship of coexisting extranidal aneurysms to intracranial hemorrhage in patients harboring brain arteriovenous malformations. Neurosurgery 2004; 54 (6) 1349-1357 , discussion 1357–1358
  • 14 Isokangas JM, Siniluoto T, Tikkakoski T, Kumpulainen T. Endovascular treatment of peripheral aneurysms of the posterior inferior cerebellar artery. AJNR Am J Neuroradiol 2008; 29 (9) 1783-1788
  • 15 Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP. Endovascular treatment of peripheral cerebellar artery aneurysms. AJNR Am J Neuroradiol 2003; 24 (6) 1208-1213
  • 16 Drake CG. Bleeding aneurysms of the basilar artery. Direct surgical management in four cases. J Neurosurg 1961; 18: 230-238
  • 17 Drake CG, Peerless SJ, Hernesniemi JA. Surgery of Vertebrobasilar Aneurysms—London, Ontario Experience on 1767 Patients. Vienna, Austria: Springer-Verlag Wien Publishers; 1995
  • 18 Hernesniemi J, Vapalahti M, Niskanen M, Kari A. Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 1992; 31 (5) 857-861 , discussion 861–862
  • 19 Redekop G, TerBrugge K, Montanera W, Willinsky R. Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg 1998; 89 (4) 539-546
  • 20 Sundt Jr TM, Kobayashi S, Fode NC, Whisnant JP. Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. Related and unrelated to grade of patient, type of aneurysm, and timing of surgery. J Neurosurg 1982; 56 (6) 753-765
  • 21 Yamamoto I, Tsugane R, Ohya M, Sato O, Ogura K, Hara M. Peripheral aneurysms of the posterior inferior cerebellar artery. Neurosurgery 1984; 15 (6) 839-845
  • 22 Eskridge JM, Song JK. Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 1998; 89 (1) 81-86
  • 23 Molyneux AJ, Kerr RSC, Yu LM , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. . International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 (9488) 809-817
  • 24 Mintz A, Cosgrove GR. Multiple peripheral aneurysms of the posterior inferior cerebellar artery associated with a cerebellar arteriovenous malformation: case report. Neurosurgery 1990; 26 (3) 533-536 , discussion 536–537
  • 25 Andreou A, Ioannidis I, Mitsos A. Endovascular treatment of peripheral intracranial aneurysms. AJNR Am J Neuroradiol 2007; 28 (2) 355-361
  • 26 Chaloupka JC, Putman CM, Awad IA. Endovascular therapeutic approach to peripheral aneurysms of the superior cerebellar artery. AJNR Am J Neuroradiol 1996; 17 (7) 1338-1342
  • 27 Lasjaunias P, Manelfe C, Terbrugge K, Lopez Ibor L. Endovascular treatment of cerebral arteriovenous malformations. Neurosurg Rev 1986; 9 (4) 265-275
  • 28 Peluso JPP, van Rooij WJ, Sluzewski M, Beute GN. Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular parent vessel occlusion. AJNR Am J Neuroradiol 2007; 28 (8) 1573-1578
  • 29 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 (1) 82-88 , discussion 88
  • 30 Thompson RC, Steinberg GK, Levy RP, Marks MP. The management of patients with arteriovenous malformations and associated intracranial aneurysms. Neurosurgery 1998; 43 (2) 202-211 , discussion 211–212
  • 31 Mpotsaris A, Loehr C, Harati A, Lohmann F, Puchner M, Weber W. Interdisciplinary clinical management of high grade arteriovenous malformations and ruptured flow-related aneurysms in the posterior fossa. Interv Neuroradiol 2010; 16 (4) 400-408
  • 32 Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986; 64 (5) 724-730
  • 33 Redekop GJ, Durity FA, Woodhurst WB. Management-related morbidity in unselected aneurysms of the upper basilar artery. J Neurosurg 1997; 87 (6) 836-842