Indian Journal of Neurosurgery 2014; 03(03): 158-162
DOI: 10.4103/2277-9167.146832
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

Giant partially thrombosed 4th ventricular posterior inferior cerebellar artery aneurysm; microsurgical management

Forhad Hossain Chowdhury
,
Mohammod Raziul Haque

Subject Editor:
Further Information

Publication History

Publication Date:
18 January 2017 (online)

Abstract

A 42-year-old woman presented with a 3-month history of progressive occipital headache, vomiting, walking difficulty, and repeated fall. She had no history of sudden and severe headache. She had positive cerebellar signs, predominantly on the right side. Computerized tomography (CT) scan, CT angiogram, and magnetic resonance image (MRI) of the brain showed suspected partially thrombosed giant 4th ventricular posterior inferior cerebellar artery aneurysm. Patient developed severe hypersensitivity reaction during both CT scan and MRI after contrast injection. Though needed, digital subtraction angiogram (DSA) of cerebral vessels was not done. The aneurysm was managed by microsurgical clipping of the aneurysm neck and partial excision of thrombosed aneurysm. Here, we report the details of management of these difficult giant aneurysm without DSA.

 
  • References

  • 1 Lim DH, Jung S, Jung TY, Kim TS. An unusual case of a thrombosed giant distal PICA aneurysm simulating a large cavernous angioma. J Korean Neurosurg Soc 2008; 43: 155-158
  • 2 Singh RK, Behan S, Kumar V, Jaiswal AK, Jain VK. Posterior inferior cerebellar artery aneurysms: Anatomical variations and surgical strategies. Asian J Neurosurg 2012; 7: 2-11
  • 3 Rodriguez-Hernandez A, Lawton MT. Anatomical triangles defining surgical routes to posterior inferior cerebellar artery aneurysms. J Neurosurg 2011; 114: 1088-1094
  • 4 Lewis SB, Chang DJ, Peace DA, Lafrentz PJ, Day AL. Distal posterior inferior cerebellar artery aneurysms: Clinical features and management. J Neurosurg 2002; 97: 756-766
  • 5 Krayenbuhl N, Guerrero C, Krisht AF. Technical strategies to approach aneurysms of the vertebral and posterior inferior cerebellar arteries. Neurosurg Focus 2005; 19: E4
  • 6 Heros RC. Posterior inferior cerebellar artery. J Neurosurg 2002; 97: 747-748
  • 7 Kallmes DF, Lanzino G, Dix JE, Dion JE, Do H, Woodcock RJ. et al Patterns of hemorrhage with ruptured posterior inferior cerebellar artery aneurysms: CT findings in 44 cases. AJR Am J Roentgenol 1997; 169: 1169-1171
  • 8 Schubiger O, Valavanis A, Hayek J. Computed tomography in cerebral aneurysms with special emphasis on giant intracranial aneurysms. J Comput Assist Tomogr 1980; 4: 24-32
  • 9 Belec L, Cesaro P, Brugieres P, Gray F. Tumor-simulating giant serpentine aneurysm of the posterior cerebral artery. Surg Neurol 1988; 29: 210-215
  • 10 Ahn JY, Chung YS, Kim OJ, Choi SW. Medial trunk aneurysm of the distal posterior inferior cerebellar artery in the fourth ventricle. J Korean Neurosurg Soc 2003; 34: 57-60
  • 11 Cho YD, Han MH, Lee JY. Double origin of the posterior inferior cerebellar artery with juxta-proximal fenestration of caudal component. Surg Radiol Anat 2011; 33: 271-273
  • 12 Matsumoto J, Uemura S, Hayasaki A, Kimura H, Morioka M, Kuratsu J. Ruptured aneurysm at an anastomotic artery extending from the vertebral artery to the posterior inferior cerebellar artery: A case report. Acta Neurochir (Wien) 2011; 153: 931-935
  • 13 Matsushima T, Matsukado K, Natori Y, Inamura T, Hitotsumatsu T, Fukui M. Surgery on a saccular vertebral artery-posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the transcondylar approach: Surgical results and indications for using two different lateral skull base approaches. J Neurosurg 2001; 95: 268-274
  • 14 Al-khayat H, Al-Khayat H, Beshay J, Manner D, White J. Vertebral artery-posteroinferior cerebellar artery aneurysms: Clinical and lower cranial nerve outcomes in 52 patients. Neurosurgery 2005; 56: 2-10
  • 15 Nourbakhsh A, Katira KM, Notarianni C, Vannemreddy P, Guthikonda B, Nanda A. Long-term follow-up of disability among patients with posterior inferior cerebellar artery aneurysm. J Clin Neurosci 2010; 17: 980-983
  • 16 Mukonoweshuro W, Laitt RD, Hughes DG. Endovascular treatment of PICA aneurysms. Neuroradiology 2003; 45: 188-192
  • 17 Bradac GB, Bergui M. Endovascular treatment of the posterior inferior cerebellar artery aneurysms. Neuroradiology 2004; 46: 1006-1011