A case with coil embolization for ruptured aneurysm associated with fenestration of the posterior inferior cerebellar artery

Abstract

<jats:p> An 87-year-old man hospitalized for subarachnoid hemorrhage showed a ruptured aneurysm arising from fenestration of the posterior inferior cerebellar artery. Endovascular treatment was selected and the aneurysm and superior limb were embolized completely using three coils. Fenestration of the posterior cerebellar artery is exceedingly rare. In addition, we present a first case of aneurysm as fenestration of the posterior inferior cerebellar artery that was definitively identified as a cause of bleeding. </jats:p>

Endovascular management of a ruptured aneurysm associated with distal PICA fenestration

“…PICA fenestrations are exceedingly rare, with only six cases reported in the literature. 1,10–14 All reported cases except one showed fenestration in the proximal medullary segment, which is analogous to the radiculopial artery supplying the spinal cord. A proposed embryological basis includes partial regression of a double origin of the PICA or cranial nerve entrapment by circumscribed fenestrations.…”

“…To the best of our knowledge, only a single case of distal PICA fenestration has been reported in the literature. 14 The exact embryological basis of distal PICA fenestration is not known.…”

“…13 reported a case of double origin of the left PICA with fenestration of its caudal channel and right V4 segment dissecting aneurysm. Maeda and colleagues 14 reported a case of PICA fenestration with a ruptured aneurysm in the cranial loop of the telovelotonsilar segment that was subsequently managed by endovascular coiling. Our case also showed PICA fenestration distal to the tonsilomedullary segment with a ruptured aneurysm in one of its limbs.…”

“…To the best of our knowledge, only six cases of PICA fenestration have been reported in the literature. 1,10–14 Among these, only one case report involved PICA fenestration beyond its tonsilomedullary segment. 14 Here we report possibly the second in the literature, a case of distal PICA fenestration with ruptured aneurysm of one of its limbs successfully managed by endovascular coiling.…”

Coiling for a saccular aneurysm on the caudal channel in double origin of the posterior inferior cerebellar artery

“…14,17 Variations of the PICA include absent, single trunk, duplication, fenestration and DOPICA. [17][18][19][20][21][22] Other variations include VA termination of the PICA, 23 extradural origin at the C-1 and C-2 level and origin from the hypoglossal, pro-atlantal and posterior meningeal arteries. 17,24 Among them, DOPICA is a rare anatomical variation 1,2,4,7,11,12,22,24,25 that was first described by Stopford in 1916, and that reportedly occurs in 1/150 individuals.…”