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International Journal of Neurology and Neurotherapy





DOI: 10.23937/2378-3001/3/1/1039



Ruptured Anterior Inferior Cerebellar Artery Aneurysm

Masaru Honda* and Takeo Anda



Department of Neurosurgery, Shunan Memorial Hospital, Japan


*Corresponding author: Masaru Honda, Department of Neurosurgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu City, Yamaguchi 744-0033 Japan, Tel: +81-833-45-3330, Fax: +81-833-45-3335, E-mail: dahon1007@yahoo.co.jp
Int J Neurol Neurother, IJNN-3-039, (Volume 3, Issue 1), Case Report; ISSN: 2378-3001
Received: January 19, 2016 | Accepted: January 28, 2016 | Published: January 30, 2016
Citation: Honda M, Anda T (2016) Ruptured Anterior Inferior Cerebellar Artery Aneurysm. Int J Neurol Neurother 3:039. 10.23937/2378-3001/3/1/1039
Copyright: © 2016 Honda M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Keywords

Aneurysm, Anterior inferior cerebellar artery


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Figure 1: Axial computed tomography scan revealed thick subarachnoid hemorrhage in the left cerebellopontine angle. Lt.: Left; Rt.: Right. View Figure 1



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Figure 2: Computed tomography angiography revealed an aneurysm (circle) at the meatal loop of the left anterior inferior cerebellar artery (arrow). Lt.: Left; Rt.: Right. View Figure 2



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A 85-year-old woman was accepted to our institute with complaints of a headache and vomiting after vertigo and left ear tinnitus. Computed tomography (CT) revealed subarachnoid hemorrhage (Figure 1). CT angiography identified an aneurysm at meatal loop of the left anterior inferior cerebellar artery (AICA) (Figure 2). A surgical trapping of aneurysm was performed via retrosigmoid craniectomy. The aneurysm was covered by thinned acoustic nerve and clot was found on the surface of the aneurysm, which penetrated the nerve (Figure 3). Trapping was successfully performed (Figure 4). Postoperative course was uneventful except for left ear hearing loss.


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Figure 3: Intraoperative microscopic photograph showed that the aneurysm (black arrow heads) located at the ventral side of thinned left acoustic nerve (white arrow heads). A red clot indicates rupture point of the aneurysm (arrow). A: anterior; C: caudal; P: posterior; R: rostral. View Figure 3



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Figure 4: The aneurysm was successfully trapped and the aneurysm got discolored through the acoustic nerve. View Figure 4



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Anterior inferior cerebellar artery aneurysms are reported to be 0.025-0.5% of all intracranial aneurysms even in the radiological device-developed era. (Table 1) [1-22]. They are female and middle-age dominant without laterality [2,4,5]. 80% of patients suffered subarachnoid hemorrhage [2,4-15]. The aneurysm most occurs around the meatal segment, the most curved structure of AICA [1-22]. AICA and other posterior fossa arteries develop from reticular network of arteries and contain many curvatures [3,5,7-11,13-22]. Thus, vertebral artery dominancy and hemodynamic stress affect these structures and accelerate aneurysm or other vascular anomaly formation, and vice versa. Surgical clipping, trapping with or without occipital artery bypass and endovascular therapy have been performed. It seems inevitable to cause hearing disturbance after surgery because it is difficult to identify and spare the internal auditory artery [2-4,8-11]. On the contrary, cerebellar infarction is not severe, due to collateral flow from adjacent arteries [1-22]. To keep good postoperative prognosis, electrophysiological monitoring and intraoperative indocyanine green angiography are mandatory. We believe direct surgery has advantages for blood clots removal, which prevents ventricular drainage or ventriculo-peritoneal shunting. Endovascular treatment is developing but is still reserved for special cases [17-22].



Table 1: Summary of reported cases of distal anterior cerebellar artery aneurysms. View Table 1


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