J Cerebrovasc Endovasc Neurosurg.  2012 Mar;14(1):29-36. 10.7461/jcen.2012.14.1.29.

Endovascular and Microsurgical Treatment of Superior Cerebellar Artery Aneurysms

Affiliations
  • 1Department of Neurosurgery, Haeundae Paik Hospital, Inje University, Pusan, Korea.
  • 2Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. ykwon@amc.seoul.kr
  • 3Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

Abstract


OBJECTIVE
Superior cerebellar artery (SCA) aneurysms are regarded as being as difficult to treat surgically as posterior circulation aneurysms. We describe here a series of 33 of these aneurysms treated with microsurgery or embolization.
METHODS
Between June 1997 and August 2007, 33 patients (9 men, 24 women; age, 29 to 76 years) with SCA aneurysms underwent microsurgical (n = 12) or endovascular (n = 21) treatment. Twenty two patients presented with subarachnoid hemorrhage. Thirty aneurysms were located in the junction between the SCA and the basilar artery (BA), two in the proximal SCA (S1) and one in the distal SCA (S2-3).
RESULTS
Of the 29 SCA aneurysms, located in the junction between the SCA and BA, which were available on conventional angiography, 20 were lateral-superior, six lateral-horizontal, two lateral inferior, and one posterior type. Of the 12 patients treated microsurgically, eight had clinically excellent or good outcomes. Causes of poor outcomes included initial poor clinical status (n = 2), infarction due to parent artery compromise (n = 1), and artery of Heubner injury due to surgery for a coexisting anterior communicating artery aneurysm (n = 1). Of the 21 patients treated endovascularly, 17 had clinical good or excellent outcomes. Causes of clinically poor outcomes included initial poor clinical status (n = 2) and infarction due to thrombosis of exposed coil mesh (n = 1). One patient underwent embolization resulted in death due to vasospasm. Three patients required additional embolization for coil compaction.
CONCLUSION
There was no morbidity related to perforator injury, regardless of the treatment modality. Embolization or microsurgery is an effective modality, with relatively low procedural morbidity and mortality rates.

Keyword

Aneurysm; Endovascular; Microsurgery; Superior cerebellar artery

MeSH Terms

Aneurysm
Angiography
Arteries
Basilar Artery
Humans
Infarction
Intracranial Aneurysm
Male
Microsurgery
Parents
Subarachnoid Hemorrhage
Thrombosis

Figure

  • Fig. 1 Classification of Superior Cerebellar Artery (SCA) aneurysm according to angiographic features.


Cited by  1 articles

Fusiform Superior Cerebellar Artery Aneurysm Treated with Endovascular Treatment
Joon Bok Jeon, Se-yang Oh, Dong-Keun Hyun, Yu Shik Shim
J Cerebrovasc Endovasc Neurosurg. 2016;18(3):276-280.    doi: 10.7461/jcen.2016.18.3.276.


Reference

1. Agostinis C, Caverni L, Moschini L, Rottoli MR, Foresti C. Paralysis of fourth cranial nerve due to superior-cerebellar artery aneurysm. Neurology. 1992. 02. 42(2):457–458.
2. Batjer HH, Samson DS. Causes of morbidity and mortality from surgery of aneurysms of the distal basilar artery. Neurosurgery. 1989. 12. 25(6):904–915. discussion 915-6.
Article
3. Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC Jr, Brott T, et al. Recommendations for the management of patients with unruptured intracranial aneurysms: A Statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 2000. 11. 31(11):2742–2750.
4. Chaloupka JC, Putman CM, Awad IA. Endovascular therapeutic approach to peripheral aneurysms of the superior cerebellar artery. AJNR Am J Neuroradiol. 1996. 08. 17(7):1338–1342.
5. Cloft HJ, Kallmes DF, Jensen ME, Lanzino G, Dion JE. Endovascular treatment of ruptured, peripheral cerebral aneurysms: parent artery occlusion with short Guglielmi detachable coils. AJNR Am J Neuroradiol. 1999. 02. 20(2):308–310.
6. Cognard C, Weill A, Tovi M, Castaings L, Rey A, Moret J. Treatment of distal aneurysms of the cerebellar arteries by intraaneurysmal injection of glue. AJNR Am J Neuroradiol. 1999. 05. 20(5):780–784.
7. Collins TE, Mehalic TF, White TK, Pezzuti RT. Trochlear nerve palsy as the sole initial sign of an aneurysm of the superior cerebellar artery. Neurosurgery. 1992. 02. 30(2):258–261.
Article
8. Eckard DA, O'Boynick PL, McPherson CM, Eckard VR, Han P, Arnold P, et al. Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms. AJNR Am J Neuroradiol. 2000. 01. 21(1):137–142.
9. Gacs G, Vinuela F, Fox AJ, Drake CG. Peripheral aneurysms of the cerebellar arteries. Review of 16 cases. J Neurosurg. 1983. 01. 58(1):63–68.
10. Haw C, Willinsky R, Agid R, TerBrugge K. The endovascular management of superior cerebellar artery aneurysms. Can J Neurol Sci. 2004. 02. 31(1):53–57.
Article
11. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968. 01. 28(1):14–20.
Article
12. Jin SC, Ahn JS, Kwun BD, Kwon DH. Analysis of clinical and radiological outcomes in microsurgical and endovascular treatment of basilar apex aneurysms. J Korean Neurosurg Soc. 2009. 04. 45(4):224–230.
Article
13. Lempert TE, Malek AM, Halbach VV, Phatouros CC, Meyers PM, Dowd CF, et al. Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes. Stroke. 2000. 01. 31(1):100–110.
14. Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP. Endovascular treatment of peripheral cerebellar artery aneurysms. AJNR Am J Neuroradiol. 2003. Jun-Jul. 24(6):1208–1213.
15. Nagasawa S, Kobata H, Aoki J, Kawanishi M, Ohta T. A large thrombosed superior cerebellar artery aneurysm: a case report. Surg Neurol. 1996. 01. 45(1):36–38.
Article
16. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN. Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular parent vessel occlusion. AJNR Am J Neuroradiol. 2007. 09. 28(8):1573–1578.
Article
17. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN. Superior cerebellar artery aneurysms: incidence, clinical presentation and midterm outcome of endovascular treatment. Neuroradiology. 2007. 09. 49(9):747–751.
Article
18. Pierot L, Boulin A, Castaings L, Rey A, Moret J. Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery. 1996. 05. 38(5):948–953. discussion 953-4.
Article
19. Rhoton AL Jr. The cerebellar arteries. Neurosurgery. 2000. 09. 47(3):S29–S68.
Article
20. Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke. 2001. 09. 32(9):1998–2004.
Article
21. Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L'Esperance G. Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol. 1997. 08. 18(7):1207–1215.
Article
22. Sagoh M, Hirose Y, Murakami H, Mayanagi K. The outcome of early surgical management of ruptured posterior circulation aneurysms. Neurol Res. 1997. 08. 19(4):385–388.
Article
23. Sanai N, Tarapore P, Lee AC, Lawton MT. The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgery. 2008. 06. 62(6):1236–1249. discussion 1249-53.
24. Uda K, Murayama Y, Gobin YP, Duckwiler GR, Vinuela F. Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: clinical experience with 41 aneurysms in 39 patients. J Neurosurg. 2001. 10. 95(4):624–632.
25. Ushikoshi S, Kikuchi Y, Houkin K, Miyasaka K, Abe H. Aggravation of brainstem symptoms caused by a large superior cerebellar artery aneurysm after embolization by Guglielmi detachable coils-case report. Neurol Med Chir (Tokyo). 1999. 07. 39(7):524–529.
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