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.
Cavernous angioma is encountered most frequently in正 ntraorbital tumors , It is important to know the detailed anatomy of the orblt in order to approach such a mass lesion , so we studied the microsurgical anatomy of the orbit using cadaver heads. In 3 clinical cases reported here , the mass was all located within the muscle cone , ln which the optic nerve was dispiaced medially and superiorly in 2 cases and was displaced laterally and superiorly in l case . The tumor was approached through fronto − orbital craniotonly with additional orbitotomy and was removed en bloc using a coagulation technique by a lateral route in 2 cases and by a medial route in l case . Postoperatively proptosis , diplopia and anisocoria were observed ;however, these cleared up except for mild anisocoria within a few months .
Summary:We report the case of 41-year-old woman with a de novo aneurysm originating at the antero-lateral wall of the contralateral internal carotid artery (ICA) 31 days after the cerebral infarction due to the dissection of the ipsilateral cervical ICA. She developed right hemiparesis and aphasia. Head CT showed fresh cerebral infarction in the left ICA territory, and head MRA showed a stenosis in the left cervical ICA. Carotid ultrasonography indicated an intramural hematoma at the origin of the left ICA, and staccato flow was observed on the Doppler examination, suggesting the dissection of the ICA.Although neuroprotective and anticoagulant therapies were carried out, she developed a sudden severe headache and generalized convulsion on Day 31 since cerebral infarction. Head CT revealed subarachnoid hemorrhage, and a following 3D-CT angiogram showed a saccular de novo aneurysm at the anterolateral and non-branching wall of the supraclinoid ICA on the right. We performed right fronto-temporal craniotomy and neck clipping of the aneurysm. Since no aneurysms had been observed at the affected site on the initial MRA, which was conducted at the onset of cerebral infarction, it was surmised that a de novo aneurysm developed over a short period of time as a result of the hemodynamic stress after the occlusion of the left ICA.This case study may be of importance for clarifying the pathogenesis of aneurysms.
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