Objectives: We herein report a case of a ruptured intrameatal aneurysm of the distal anterior inferior cerebellar artery (AICA) treated by coil embolization with preservation of the parent artery in the acute stage. We also discuss the efficacy of endovascular treatment (EVT) for such a lesion. Case presentation: An 83-year-old woman developed headache and vomiting of sudden onset and was urgently transported to our hospital. Head CT revealed subarachnoid hemorrhage, but cerebral angiography performed on the same day did not reveal the causative pathology. Vertebral angiography was performed 5 days later and demonstrated a small aneurysm of the right distal AICA. 3D-CT showed that the aneurysm was located in the internal auditory meatus. Considering the patient's age, clinical course, and aneurysm site, we chose to perform EVT rather than direct surgery. Two sessions of coil embolization were required for complete packing of the aneurysm because of regrowth of the residual neck after the first EVT. After EVT, the patient developed right-sided ataxia due to a small infarction of the middle cerebellar peduncle. However, the ataxia resolved rapidly, and she was transferred for rehabilitation on day 28. Conclusion: Intrameatal aneurysm is rare. EVT may be a good treatment choice for such an aneurysm because of its minimal invasiveness and its ability to prevent damage to cranial nerves VII and VIII in the acute stage.
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