J Cerebrovasc Endovasc Neurosurg.  2014 Mar;16(1):20-25. 10.7461/jcen.2014.16.1.20.

Endovascular Treatment for Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm

• Oh JS
• Yoon SM
• Shim JJ
• Bae HG
• Yoon IG

• KMID: 2055280
• DOI: http://doi.org/10.7461/jcen.2014.16.1.20

Abstract

A 42-year-old woman presented with Hunt and Hess grade (HHG) III subarachnoid hemorrhage (SAH) caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin SAH on the cerebellopontine angle cistern, and small vermian intracerebral hemorrhage and intraventricular hemorrhage in the fourth ventricle. Digital subtraction angiography revealed the aneurysm on the postmeatal segment of left distal AICA, a branching point of rostrolateral and caudomedial branch of the left distal AICA. Despite thin caliber, tortuous running course and far distal location, the AICA aneurysm was obliterated successfully with endovascular coils without compromising AICA flow. However, the patient developed left side sensorineural hearing loss postoperatively, in spite of definite patency of distal AICA on the final angiogram. She was discharged home without neurologic sequela except hearing loss and tinnitus. Endovascular treatment of distal AICA aneurysm, beyond the meatal loop, is feasible while preserving the AICA flow. However, because the cochlear hair cell is vulnerable to ischemia, unilateral hearing loss can occur, possibly caused by the temporary occlusion of AICA flow by microcatheter during endovascular treatment.

Keyword

Subarachnoid hemorrhage; Cerebellar artery; Endovascular; Hearing loss

MeSH Terms

Adult
Aneurysm*
Angiography, Digital Subtraction
Arteries*
Cerebellopontine Angle
Cerebral Hemorrhage
Female
Fourth Ventricle
Hair
Hearing Loss
Hearing Loss, Sensorineural
Hearing Loss, Unilateral
Hemorrhage
Humans
Ischemia
Running
Subarachnoid Hemorrhage
Tinnitus

Figure

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  Fig. 1 Computed tomography (CT) shows a subarachnoid hemorrhage (SAH) on cerebellopontine angle cistern, intraventricular hemorrhage (IVH) in the 4th ventricle and a small vermian intracerebral hemorrhage (ICH) (Fisher grade 4).

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  Fig. 2 Digital subtraction angiography reveals an aneurysm arising on the branch point of the caudomedial and rostrolateral branch of the left distal anterior inferior cerebellar artery (AICA), which is on distal to meatal loop. (A) On 3D rotational angiogram, the aneurysm is located on postmeatal segment of left AICA (arrow). (B) The aneurysm is 2.7×2.8 mm with a 1.5 mm neck, directed caudo-laterally. It is separated from two distal AICA branches, and the aneurysm had a fenestrated neck. The caudomedial branch of distal AICA (arrow) is slightly thicker than the rostrolateral branch.

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  Fig. 3 Even though superselection of AICA orifice was not difficult, aneurysm selection was very difficult due to the tortuous course of AICA and relatively small diameter of AICA to accommodate microcatheter. The 2nd coil is extruded from the aneurysmal sac during coiling (arrow).

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  Fig. 4 The aneurysmal sac is obliterated completely without compromise of AICA branch even though 2nd coil is extruded from the aneurysmal sac during coiling (right image is the subtraction of coil). There is no occlusion or stenosis of distal AICA.

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