Clip Reconstruction for a Case of Peripheral Posterior Inferior Cerebellar Artery Aneurysm: Case Report

Abstract

The authors report an unusual surgical treatment for an aneurysm on the left peripheral posterior inferior cerebellar artery (PICA). The computed tomographic scan showed subarachnoid haemorrhage and a haematoma in the left cerebellar region close to the fourth ventricle. The 3D CT angiography demonstrated an aneurysm on the left peripheral PICA which was confirmed on four-vessel angiography. The aneurysm was approached through a posterior suboccipital craniotomy and the PICA was reconstructed with multiple clips. The literature concerning peripheral PICA aneurysms and their treatment is reviewed and discussed.

Key words

Posterior inferior cerebellar artery - aneurysm - clip - reconstruction - fourth ventricle

References

• 1 Yeh H S, Tomsick T A, Tew Jr J M. Intraventricular haemorrhage due to aneurysms of the distal posterior inferior cerebellar artery.  J Neurosurg. 1985;  62 772-775
• 2 Hudgins R J, Day A L, Quisling R G, Rhoton Jr A L, Sypert G W, Garcia-Bengochea F. Aneurysms of the posterior inferior cerebellar artery: A clinical and anatomical analysis.  J Neurosurg. 1983;  58 381-387
• 3 Pia H W. Classification of vertebro-basilar aneurysms.  Acta Neurochir (Wien). 1979;  47 3-30
• 4 Yamamoto I, Tsugane R, Ohya M, Sato O, Ogura K, Hara M. Peripheral aneurysm of the posterior inferior cerebellar artery.  Neurosurgery. 1984;  15 839-845
• 5 Winn H R. Youmans Textbook of Neurological Surgery; 5th edn, Vol 2. New York: WB Saunders Co 2003: 2007-2015
• 6 Beyerl B D, Heros R C. Multiple aneurysms of the posterior inferior cerebellar artery.  Neurosurgery. 1986;  19 285-289
• 7 Hook O, Norlen G, Guzman J. Saccular aneurysms of the vertebral-basilar arterial system: A report of 28 cases.  Acta Neurol Scand. 1963;  39 271-304
• 8 Nishikazi T, Tamaki N, Nishida Y, Fujita K, Matsumoto S. Aneurysms of the distal posterior inferior cerebellar artery: Experience with three cases and review of the literature.  Neurosurgery. 1985;  16 829-832
• 9 Rothman S LG, Azar-Kia B, Kier E L, Schechter M M, Allen III W E. The angiography of posterior inferior cerebellar artery aneurysms.  Neuroradiology. 1973;  6 1-7
• 10 Sutton D, Trickey S E. Subarachnoid haemorrhage and total cerebral angiography.  Clin Radiol. 1962;  13 297-303
• 11 Lister J R, Rhoton A L, Matsushima T, Peace D A. Microsurgical anatomy of the posterior inferior cerebellar artery.  Neurosurgery. 1982;  10 170-199
• 12 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 12-21
• 13 Rhoton Jr A L. Cranial anatomy and surgical approaches.  Neurosurgery. 2003;  53 (Part 3) 483-499
• 14 Nussbaum E S, Mendez A, Camarata P, Sebring L. Surgical management of fusiform aneurysm of the peripheral posterior inferior cerebellar artery.  Neurosurgery. 2003;  53 831-834
• 15 Ausman J I, Diaz F G, Mullan S, Gehring R, Sadasivan B, Dujovny M. Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm.  J Neurosurg. 1990;  73 462-465
• 16 Lee S Y, Sekhar L N. Treatment of aneurysms by trapping with arterial reimplantation or interposition grafting.  J Neurosurg. 1996;  85 178-185
• 17 Lemole Jr G M, Henn J, Javedan S, Deshmukh V, Spetzler R F. Cerebral revascularization performed using posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass: Report of four cases and literature review.  J Neurosurg. 2002;  97 219-223
• 18 Hamada J, Nagahiro S, Mimata C, Kaku T, Ushio Y. Reconstruction of the posterior inferior cerebellar artery in the treatment of giant aneurysm. Report of two cases.  J Neurosurg. 1996;  85 496b-499b
• 19 Hammon W M, Kempe L G. The posterior fossa approach to aneurysms of the vertebral and basilar arteries.  J Neurosurg. 1972;  37 339-347
• 20 Yamaura A, Ise H, Makino H. Radiometric study on posterior inferior cerebellar aneurysms with special reference to accessibility by the lateral suboccipital approach.  Neurol Med Chir (Tokyo). 1981;  21 721-733
• 21 Kato Y, Sano H, Imizu S, Yoneda M, Viral M, Nagata J, Kanno T. Surgical strategies for the treatment of giant or large intracranial aneurysms: our experience with 139 cases.  Minim Invas Neurosurg. 2003;  46 339-343