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

Abstract

Dissecting aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Few reports suggested that coil embolization and parent artery occlusion (PAO) would be valuable treatment options against dissecting AICA aneurysms. We report a case of PAO against dissecting aneurysm involving the proximal AICA and discuss the therapeutics and literature review of this pathology. A 69-year-old woman was referred to our hospital, and neurological examination revealed a semicoma (Hunt and Hess grade IV). Brain computed tomography (CT) established the diagnosis of Fisher group 3 subarachnoid hemorrhage (SAH), CT angiography revealed an extravasation near the clivus, while digital subtraction angiography showed no signs of dissection. Conservative treatment was administered, and repeated angiography on day 13 showed a pseudoaneurysm and false lumen in the left proximal AICA. The patient was in poor health condition, and endovascular therapy (EVT) of the left AICA was performed to minimize invasion. The PAO was successful with no severe ischemic damage to the brainstem and cerebellum. However, the general condition gradually deteriorated, and the patient expired on day 24. Since open surgery for dissecting AICA aneurysm is technically challenging and revascularization procedure is often required, the rapidly developing EVT is a viable alternative. Although preservation of the proximal AICA is usually necessary, PAO without revascularization procedure was performed to avoid the high risk of regrowth and re-rupture of the dissecting aneurysm with respect to the patient’s poor health condition. Hence, EVT is a viable option when microsurgery is contraindicated for treating dissecting AICA aneurysms.

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.…”

Perioperative and long-term complications following therapeutic internal carotid artery occlusion

“…Parent artery occlusion (PAO) of the internal carotid artery (ICA) is a major therapeutic option for dissecting fusiform aneurysms, large or giant aneurysms, iatrogenic or traumatic pseudoaneurysms, and carotid-cavernous fistulas. 1–5 PAO is a safe and feasible treatment option depending on the mechanism and pathogenesis of the aneurysm. 3,4…”

“…Parent artery occlusion (PAO) of the internal carotid artery (ICA) is a major therapeutic option for dissecting fusiform aneurysms, large or giant aneurysms, iatrogenic or traumatic pseudoaneurysms, and carotid-cavernous fistulas. [1][2][3][4][5] PAO is a safe and feasible treatment option depending on the mechanism and pathogenesis of the aneurysm. 3,4 Although PAO is used in various clinical scenarios to treat several diseases, perioperative cerebral infarction and long-term complications may occur due to major vessel occlusion.…”