Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery —Case Report—

Kawaguchi, Shoichiro; Sakaki, Toshisuke; Kamada, Kiyoshi; Iwanaga, Hideaki; Takehashi, Katsushige; Tsujimoto, Masahiko

doi:10.2176/nmc.33.634

Cited by 24 publications

(7 citation statements)

References 12 publications

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“…1,4,5,10,11) However, conservative treatment might be chosen for non-hemorrhagic lesion in consideration of spontaneous healing. 1,2),7) …”

Section: Discussionmentioning

confidence: 99%

“…12) Previous reports in pathology showed hemorrhage dissected through and accumulated into the adventitia with inflammatory cells in part of SAH cases 6,8,13,14) and smooth muscle was remaining without inflammatory cells in infarct cases. 3,4) Takahashi et al reported PICA ruptured DA from giant cell angiitis. 6) The adventitia had CD68 positive macrophages in this case (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Pathological Considerations for Unruptured Dissecting Aneurysm in the Posterior Inferior Cerebellar Artery: Case Report

Miyamoto

Nakayama

Hokari

et al. 2014

NMC Case Report Journal

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Because of the wide spread of magnetic resonance image (MRI), it may be increasing to find a dissecting aneurysm (DA) of the posterior inferior cerebellar artery (PICA) that causes headache without associated hemorrhage or infarction. Generally, surgical treatment might be considered in cases of DA with hemorrhage. However, the treatment of an unruptured DA with headache or infarction has not been well established. This is the first report regarding the pathology of an intact DA of the PICA that presents with headache only, and the pathological findings showed interesting figures. A 44-year-old man with an unruptured DA of the left PICA presented with sudden left occipital headache. MRI revealed no hemorrhage or infarction. Magnetic resonance angiography (MRA) showed growth of the DA 12 days after the onset of headache. Therefore, surgery was performed to prevent aneurysmal rupture. This DA aneurysm was trapped and removed after an occipital artery (OA)-PICA anastomosis was performed. The surgery was performed without complication. Pathological findings showed folding of the internal elastic lamina, and the true lumen was torn by the false lumen. The dissection reached the adventitia and the wall had numerous macrophages. Pathological findings might help understanding the etiology of DAs and inflammation might play an important role in DAs.

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“…1,4,5,10,11) However, conservative treatment might be chosen for non-hemorrhagic lesion in consideration of spontaneous healing. 1,2),7) …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pathological Considerations for Unruptured Dissecting Aneurysm in the Posterior Inferior Cerebellar Artery: Case Report

Miyamoto

Nakayama

Hokari

et al. 2014

NMC Case Report Journal

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“…Si no existen perforantes como en nuestro enfermo se puede sacrificar esa parte del vaso. La pertinencia de realizar además un "by-pass" de la PICA distal al aneurisma, que es sin duda un procedimiento muy elegante, es recomendado por varios autores 8,[10][11][12]20,32 . Sin embargo, para otros es discutible, ya que únicamente permitiría revascularizar las partes más distales de la PICA y no el segmento de la arteria enfermo del que se originan las perforantes 21,25 .…”

Section: Discussionunclassified

Aneurisma disecante de la arteria cerebelosa posteroinferior

et al. 2007

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Dissecting aneurysms affecting exclusively to the posterior inferior cerebellar artery (PICA) are rare entities. Depending on the dissecting plane of the arterial wall, the clinical manifestations are subarachnoid hemorrhage (SAH) due to rupture or ischemia caused by stenosis or occlusion. Angiographic findings are fusiform dilatation with a narrowing of various degrees proximal to and distal to the fusiform lesion. Magnetic resonance imaging (MRI) can be useful demonstrating the intramural hematoma. We report a 47-year-old man who suffered from SAH. He was neurologicaly intact and vertebral angiography demonstrated and fusiform aneurysm at the origin of the left PICA. He was operated by trapping of the dissecting segment. The patient's postoperative course was uneventful despite of severe vasospasm showed in follow up angiography. Aggressive treatment has been recommended for dissecting aneurysms of the PICA and specially for those presenting with SAH. Both the surgical and endovascular procedures are effective and with good results.

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“…In patients with ischemic symptoms, some authors performed proximal occlusion of the parent artery [75,95], trapping with bypass [99], resection and bypass [61], encasement [25], or circumferential wrapping [107] with good postoperative recovery. Other surgeons are inclined to treat the patients conservatively [159,167].…”

Section: Ischemic Groupmentioning

confidence: 99%

“…PICA occlusion distal to the telovelotonsillar segment generally does not result in brainstem injury and is well tolerated in majority of cases [1,47,59,61,82,83,106,163]. Some patients have a very large PICA that also supplies the AICA territory [106].…”

Section: Picamentioning

confidence: 99%

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

Balik

Yamada

Talari³

et al. 2016

Neurosurg Rev

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Vertebrobasilar (VB) intracranial dissecting aneurysms (IDAs) pose difficult therapeutic issues and are especially among the most difficult to manage surgically. There are, however, some cases where selective aneurysm obliteration by endovascular approach is impossible or is associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is dissecting, giant, or has a large neck. In such cases, surgical treatment may be the only alternative. Optimal management of these lesions is therefore challenging and treatment decisions have to be made on a case-by-case basis. Ideal treatment should be a complete surgical excision of the lesion; however, this procedure might only be possible after distal and proximal vessel wall occlusion which might not be tolerated by the patient depending on the location of the aneurysm. Therefore, formulation of recommendations concerning the surgical strategy remains still difficult due to inconsistency of surgical outcomes. The literature describing surgical strategy of VB IDAs is varying in quality and content, and many studies deal with only a few patients. In the presented review, the authors summarize the current knowledge on the incidence, pathogenesis, clinical presentation, and diagnostic procedures with special emphasis on surgical treatment of IDAs in posterior circulation.

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Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery —Case Report—

Cited by 24 publications

References 12 publications

Pathological Considerations for Unruptured Dissecting Aneurysm in the Posterior Inferior Cerebellar Artery: Case Report

Pathological Considerations for Unruptured Dissecting Aneurysm in the Posterior Inferior Cerebellar Artery: Case Report

Aneurisma disecante de la arteria cerebelosa posteroinferior

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

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