Vol. 26 No. 4 (2022)
CASE REPORTS

Surgical treatment of distal aneurysms on superior cerebellar artery: two case reports

pdf (Русский)
  • A.I. Somova,
  • I.V. Senko,
  • K.Yu. Orlov
A.I. Somova
Federal Center of Brain Research and Neurotechnologies, Federal Biomedical Agency
Bio
I.V. Senko
Federal Center of Brain Research and Neurotechnologies, Federal Biomedical Agency; N.V. Sklifosovskii Research Institute for Emergency Medicine of Moscow Healthcare Department
K.Yu. Orlov
Federal Center of Brain Research and Neurotechnologies, Federal Biomedical Agency; Meshalkin National Medical Research Center
Интраоперационные фотографии
DOI: https://doi.org/10.21688/1681-3472-2022-4-67-72

Published 2022-12-29

Keywords

  • Adult,
  • Aneurysm, Ruptured,
  • Case Report,
  • Intracranial Aneurysm,
  • Microsurgery,
  • Subarachnoid Hemorrhage
    • ...More
    Less

How to Cite

Somova, A., Senko, I., & Orlov, K. (2022). Surgical treatment of distal aneurysms on superior cerebellar artery: two case reports. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 26(4), 67–72. https://doi.org/10.21688/1681-3472-2022-4-67-72

Copyright (c) 2022 Somova A.I., Senko I.V., Orlov K.Yu.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Distal aneurysms of the superior cerebellar arteries (SCA) present a rare subgroup of intracranial aneurysms. Only few case reports describe this condition. Therefore, the surgical approach to treating distal SCA aneurysms remains controversial.
We are demonstrating surgical treatments of previously unavailable, distal SCA aneurysms as a number of multimodal case reports.
We describe two different ways to treat two patients with distal SCA aneurysms and provide a literature review. First, a 38-year-old patient presented with an acute subarachnoid ventricular hemorrhage due to distal SCA aneurysm rupture. Microsurgical clipping of the aneurysm was performed. Then the aneurysm ruptured intraoperatively, which required temporary clipping of the SCA trunk. The postoperative period was complicated by a progressive and eventually lethal cerebral angiospasm. Another, 36-year-old female patient was admitted in acute condition after recurrent ruptures of a distal SCA aneurysm associated with subarachnoid parenchymal hemorrhage. The patient underwent endovascular SCA deconstruction at the aneurysm level. No complications or neurological symptoms were observed postoperatively. The patient was discharged for outpatient treatment on day 4.
Endovascular surgery should be considered as a method of choice for ruptured distal SCA aneurysms. Microsurgical intervention may be an option when endovascular repair is impossible and when other surgical procedures such as removal of hematoma and prevention of occlusive hydrocephalus are required.

Received 31 August 2022. Revised 14 November 2022. Accepted 18 November 2022.

Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Contribution of the authors: The authors contributed equally to this article.

pdf (Русский)

References

  1. Peluso J.P., van Rooij W.J., Sluzewski M., Beute G.N. Superior cerebellar artery aneurysms: incidence, clinical presentation and midterm outcome of endovascular treatment. Neuroradiology. 2007;49(9):747-751. PMID: 17609935. PMCID: PMC2039855. https://doi.org/10.1007/s00234-007-0251-z
  2. Колотвинов В.С., Марченко О.В., Цориев А.Э., Страхов А.А., Ошурков П.А., Улицкий И.Р. Спонтанное тромбирование дистальной аневризмы верхней мозжечковой артерии. Нейрохирургия. 2016;(2):59-62. Kolotvinov V.S., Marchenko O.V., Tsoriev A.E., Strakhov A.A., Oshurkov P.A., Ulitskii I.R. The spontaneous thrombosis of distal aneurysm of superior cerebellar artery. Russian Journal of Neurosurgery. 2016;(2):59-62. (In Russ.)
  3. Andaluz N., Pensak M.L., Zuccarello M. Multiple, peripheral aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien). 2005;147(4):419-422. PMID: 15625587. https://doi.org/10.1007/s00701-004-0453-7
  4. Yamakawa H., Yoshimura S., Enomoto Y., Nakayama N., Iwama T. Aneurysm arising from the cortical segment of the superior cerebellar artery: a case report and review of the literatures. Surg Neurol. 2008;70(4):421-424. PMID: 18291446. https://doi.org/10.1016/j.surneu.2007.02.061
  5. Banczerowski P., Sipos L., Vajda J. Aneurysm of the internal auditory artery: our experience and review of the literature. Acta Neurochir (Wien). 1996;138(10):1157-1162. PMID:.8955433. https://doi.org/10.1007/BF01809744
  6. Rodríguez-Hernández A., Zador Z., Rodríguez-Mena R., Lawton M.T. Distal aneurysms of intracranial arteries: application of numerical nomenclature, predilection for cerebellar arteries, and results of surgical management. World Neurosurg. 2013;80(1-2):103-112. PMID: 23017587. https://doi.org/10.1016/j.wneu.2012.09.010
  7. Nussbaum E.S., Madison M.T., Goddard J.K., Lassig J.P., Nussbaum L.A. Peripheral intracranial aneurysms: management challenges in 60 consecutive cases. J Neurosurg. 2009;110(1):7-13. PMID: 18928355. https://doi.org/10.3171/2008.6.JNS0814
  8. Lister J.R., Rhoton A.L. Jr, Matsushima T., Peace D.A. Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery. 1982;10(2):170-199. PMID: 7070615.
  9. Крылов В.В., Дашьян В.Г., Сенько И.В., Григорьев И.В. Хирургия дистальных аневризм сосудов головного мозга. Микрохирургия аневризм сосудов головного мозга. М.: АБВ-пресс, 2022. С. 377-399. Krylov V.V., Dashyan V.G., Senko I.V. Grigoriev I.V. Surgery of distal cerebral aneurysms. In Microsurgery of cerebral aneurysms. Moscow: ABV press, 2022. pp. 377-399. (In Russ.)
  10. Lehto H., Harati A., Niemelä M., Dashti R., Laakso A., Elsharkawy A., Satopää J., Billon-Grand R., Canato B., Kivisaari R., Hernesniemi J. Distal posterior inferior cerebellar artery aneurysms: clinical features and outcome of 80 patients. World Neurosurg. 2014;82(5):702-713. PMID: 24937594. https://doi.org/10.1016/j.wneu.2014.06.012
  11. Lewis S.B., Chang D.J., Peace D.A., Lafrentz P.J., Day A.L. Distal posterior inferior cerebellar artery aneurysms: clinical features and management. J Neurosurg. 2002;97(4):756-766. PMID: 12405360. https://doi.org/10.3171/jns.2002.97.4.0756
  12. Wu C., Sun Z., Wang F., Xu B., Zhou D. [Surgical managements of peripheral intracranial aneurysms]. Zhonghua Yi Xue Za Zhi. 2014;94(9):698-700. PMID: 24842213.
  13. Hardy D.G., Peace D.A., Rhoton A.L. Jr. Microsurgical anatomy of the superior cerebellar artery. Neurosurgery. 1980;6(1):10-28. PMID: 7354893. https://doi.org/10.1227/00006123-198001000-00002
  14. Ascanio L.C., Ogilvy C.S., Thomas A.J., Kicielinski K., Gupta R., Alturki A.Y. Distal parent vessel occlusion of 2 superior cerebellar artery fusiform aneurysms: report of 2 cases and literature review. World Neurosurg X. 2019;3:100026. PMID: 31225519. PMCID: PMC6584478. https://doi.org/10.1016/j.wnsx.2019.100026
  15. Nishio M., Yano Y., Terada E. [Ruptured dissecting distal superior cerebellar artery aneurysm successfully treated with coil embolization: a case report]. No Shinkei Geka. 2016;44(1):53-8. PMID: 26771097. https://doi.org/10.11477/mf.1436203207
  16. Hou K., Li G., Wang X., Xu K., Yu J. Endovascular treatment for peripheral superior cerebellar artery aneurysms: current state and future considerations. World Neurosurg. 2019;127:423-433. PMID: 31028980. https://doi.org/10.1016/j.wneu.2019.04.145
  17. Ros de San Pedro J. Retrosigmoid approach for trapping and removal of a distal dissecting superior cerebellar artery aneurysm in a child. J Neurol Surg B Skull Base. 2019;80(Suppl 3):S335-S338. PMID: 31143621. PMCID: PMC6534740. https://doi.org/10.1055/s-0038-1675172