Vascular: AneurysmPosterior inferior cerebellar artery aneurysms associated with posterior fossa arteriovenous malformation: Report of five cases and literature review
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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Cited by (29)
Ruptured Distal Posterior Inferior Cerebellar Artery (PICA) Aneurysms Associated with Cerebellar Arterial Venous Malformations (AVMs): A Case Series and Review of the Literature Demonstrating the Need for Angiographic Evaluation and Feasibility of Endovascular Treatment
2017, World NeurosurgeryCitation Excerpt :Although rare, distal PICA aneurysms associated with cerebellar AVMs have been described previously in the literature, with aneurysm location most commonly being distal to the anterior medullary segment. Dating back to the paper by Kaptain et al.20 in 1999, which reported a total of 27 distal PICA aneurysms associated with posterior fossa AVMs, the addition of our literature review raises this to a total of 51 reported cases of distal PICA aneurysms associated with small cerebellar AVMs. Twelve distal PICA aneurysms case series were identified in our review of the literature that clearly include whether an associated cerebellar AVM was identified.
Distal posterior inferior cerebellar artery aneurysms: Clinical features and outcome of 80 patients
2014, World NeurosurgeryCitation Excerpt :Furthermore, distal PICA aneurysms are associated with a greater frequency of anatomical variants among VA, PICA, and AICA (48, 59). The high number of anomalies, together with morphologically atypical aneurysms, has raised concern about aneurysm formation due to hemodynamic stress related to hyperdynamic flow (5, 20, 29, 32, 39, 59), or incompleteness in embryological development leading to weakness in the vessel wall (20, 29, 32, 48). In our series, the number of AVMs was rather low, with a posterior fossa AVM in only 4 (5%) patients.
Surgical Management of Aneurysms of the Vertebral and Posterior Inferior Cerebellar Artery Complex
2012, Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results: Sixth EditionSurgical Management of Infratentorial Arteriovenous Malformations
2012, Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results: Sixth EditionRuptured aneurysm at the cortical segment of the posterior inferior cerebellar artery
2006, Journal of Clinical NeuroscienceIntracranial Aneurysms Associated with Other Lesions, Disorders or Anatomic Variations
2006, Neuroimaging Clinics of North AmericaCitation Excerpt :An incidence of 58% is reported in patients evaluated with superselective angiography [32]. Aneurysms associated with AVMs have been described as proximal aneurysms in abnormal distal locations along AVM feeding vessels, in typical proximal sites along the feeding system to the AVM and in sites remote and apparently hemodynamically unrelated to the AVM [28,29,33–39]. Proximal aneurysms on the feeders can be considered AVM flow-related (Fig. 3).