Dissecting anterior inferior cerebellar artery aneurysm treated by endovascular route: report of three cases and review

Abstract

6Interventional Radiologist, Chairman of ANGIORAD.Among the major arteries of the posterior fossa, the anterior inferior cerebellar artery (AICA) is the least likely to harbor an aneurysm, being a very rare pathology. Only two AICA aneurysms were found in 7,933 lesions 1 . In the presence of a high flow lesion, aneurysms tend to occur more commonly in the feeding arteries. These flow-related aneurysms in the posterior fossa can be found mainly associated with arteriovenous malformations (AVM) or hemangioblastomas, which represents the majority of AICA aneurysms reported 2,3 . For eight years, 1,450 aneurysms were seen in a single-center, with only two AICA aneurysms, both flow-related (AVM) 3 . Aside from flow-related aneurysms, almost all distal AICA aneurysms are dissecting aneurysms, usually presenting in otherwise healthy adults. Again the AICA is the least likely to present an isolated dissection among the major arteries. We report three cases of "spontaneous" AICA dissection aneurysms. CasesCase 1 A 47yo woman had a sudden headache with vomiting, followed by loss of consciousness. A CT showed diffuse posterior fossa subarachnoid hemorrhage. The angiography, that was immediately performed, revealed a distal right AICA aneurysm and a three dimensional reconstruction was done. The ipsilateral posterior inferior and the superior cerebelar arteries were present and with a very good diameter. Dissected AICA occlusion was decided upon and a microcatheter (ultraflow, ev3) was positioned just near do the diseased segment. A mixture of 33% cyanoacrylate and lipiodol was prepared and injected under subtracted fluoroscopy. The final control shows complete occlusion of the aneurysm and parent vessel. Case 2The second case is a 16-year-old female with complains of sudden headache and left partial facial palsy. The neurological exam revealed an important meningismus. The CT scan demonstrated a subarachnoid hemorrhage in the left pontineangle cistern and in the fourth ventricle. During angiography a distal left AICA fusiform aneurysm was demonstrated, involving the whole circumference of the vessel wall. Observe the late stagnation of contrast inside the aneurysm, suggesting the dissection etiology. A microcatheter was advanced just before the aneurysm and glue at 33% was injected (cyanoacrylate and lipiodol). The final angiogram confirms complete resolution. The partial left facial palsy had an almost complete recovery after 6 months.

Dissecting aneurysm of the anterior inferior cerebellar artery in the internal auditory canal presenting with deafness without hemorrhage: A case report and literature review

“…Among the 16 cases of dissecting AICA aneurysms reported,[ 1 , 4 , 7 , 8 , 12 , 16 , 21 , 28 , 30 , 31 , 34 , 36 ] 13 presented with SAH[ 1 , 4 , 8 , 12 , 16 , 21 , 28 , 31 , 34 , 36 ] and three, including our case, presented with nonhemorrhagic symptoms. [ 7 , 30 , 36 ] The reported treatment for the lesion included endovascular occlusion of the parent artery in 10,[ 1 , 4 , 7 , 8 , 16 , 21 , 28 , 31 , 36 ] surgical trapping in two,[ 34 , 36 ] and no direct intervention in four cases. [ 12 , 30 , 36 ] One patient developed cerebellar infarction after endovascular occlusion.…”

Parent Artery Occlusion against Dissecting Aneurysm Involving the Proximal Anterior Inferior Cerebellar Artery: Case Report and Literature Review

“…The distal flow of the AICA is dependent only on the anastomosis after occlusion, and a severe ischemic complication may occur. 4 , 15) The method of testing the safety of the PAO is by performing a super-selective balloon test occlusion: Inserting a microcatheter to the SCA or PICA and occlude the basilar artery at the origin of AICA using a balloon. However, it is difficult to capture changes of neurological symptoms in high-grade SAH during the test.…”

Spontaneous resolution of ruptured dissecting anterior inferior cerebellar artery aneurysm: A rare case report

“…treated 3 cases of dissecting AICA with endovascular occlusion. [ 17 ] Kusaka et al . reported a single case of dissecting AICA aneurysm which was treated by endovascular occlusion.…”