Early Rupture of Distal Aica Pseudoaneurysm Posttranslabyrnith Approach for Vestibular Schwannoma

Background Vestibular schwannoma resection can be performed through different approaches; the translabyrinthine approach is often utilized when the goal involves minimal cerebellar hemispheric retraction without an attempt to preserve hearing. Anterior inferior cerebellar artery (AICA) pseudoaneurysm is a potential traumatic result from dissection of the local vasculature that was previously reported after radiation therapy.

Case Report We report an unusual case of a distal AICA pseudoaneurysm rupture as an early complication of vestibular schwannoma resection following a translabyrinthine approach in a 67-year-old woman who developed diffuse subarachnoid and posterior fossa intraventricular hemorrhage as a result. An external ventricular drain was placed and an endovascular treatment of the aneurysm was attempted.

Conclusion To our knowledge, this is the first reported case of a distal AICA pseudoaneurysm rupture as a direct result of vestibular schwannoma surgical resection. The underlying mechanism is not fully clear; however, the fibrogenicity of the tumor with the possibility of compromising the wall of the vessel as a result of direct trauma during the surgery might explain such a surgical complication.