Elsevier

Surgical Neurology

Volume 51, Issue 2, February 1999, Pages 146-152
Surgical Neurology

Vascular: Aneurysm
Posterior inferior cerebellar artery aneurysms associated with posterior fossa arteriovenous malformation: Report of five cases and literature review

https://doi.org/10.1016/S0090-3019(98)00037-8Get rights and content

Abstract

BACKGROUND

The association of posterior inferior cerebellar artery (PICA) aneurysms with posterior fossa arteriovenous malformation (AVM) is uncommon. Over the past 3 years, five patients with this condition were treated at this institution. A review of the clinical history of these and other reported cases has illuminated common threads in the presentation, treatment, and outcome of these lesions.

METHODS

The findings of 27 patients (5 from our institution and 22 from the medical literature) with PICA aneurysms associated with AVMs were reviewed.

RESULTS

Eighty-four percent of individuals presented with subarachnoid hemorrhage (SAH); 89% of these episodes resulted from aneurysm rupture documented by either intraoperative inspection or autopsy. All aneurysms were located on a feeding artery to the AVM, and 81% originated from distal portions of PICA. The majority of patients presented with Hunt & Hess grade I SAH; all patients who presented with hemorrhage were treated surgically. Surgical strategy was directed both to secure the aneurysm and to resect the AVM during the course of a single procedure. Although four individuals either died on admission or in the perioperative period, overall outcome was excellent or good in 82% of patients.

CONCLUSIONS

PICA aneurysms associated with AVMs most often involve the distal segments of the artery. Patients usually present with SAH secondary to aneurysmal rupture. Surgical clipping of the aneurysm and excision of the AVM is possible in a single procedure with minimal morbidity. Overall prognosis is favorable in 80% of the cases.

Section snippets

Case 1

This 48-year-old suffered from the acute onset of headache 1 day prior to admission. She was alert, oriented, and her initial neurologic examination revealed no focal deficit. Computerized tomography (CT) of the head revealed both subarachnoid and intraventricular hemorrhage. Soon after admission, the patient developed symptomatic hydrocephalus, which responded promptly to ventriculostomy. She underwent cerebral arteriography, which demonstrated a small superior vermian AVM fed by the left PICA

Results

Results are shown in Table 1, Table 2.

Patient ages ranged from 35 to 72 years, with a mean age of 54. Sixteen patients were male and nine were female (the sex of two individuals was not documented). The mode of presentation was recorded in 25 of the 27 patients reported. Twenty-one out of 25 (84%) the patients presented with SAH, 2/25 (8%) with intraventricular hemorrhage, 1/25 (4%) with intracerebellar hemorrhage, and 1/25 (4%) suffered from vertigo referable to the mass effect from a

Discussion

The majority of reported patients with coexisting PICA aneurysms and posterior fossa AVMs present with H&H grade I or II aneurysmal SAH. Patients who experience benign clinical sequelae of their initial intracranial hemorrhage benefit from operative containment of these vascular anomalies. Generally, in the anterior and posterior circulation, surgical therapy has improved outcomes over medical treatment in individuals with tandem vascular malformations [27].

Strategy for the treatment of

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