J Korean Neurosurg Soc.  2015 Aug;58(2):141-143. 10.3340/jkns.2015.58.2.141.

Ruptured Total Intrameatal Anterior Inferior Cerebellar Artery Aneurysm

• Kim HC
• Chang IB
• Lee HK
• Song JH

• KMID: 2191323
• DOI: http://doi.org/10.3340/jkns.2015.58.2.141

Abstract

Among the distal anterior inferior cerebellar artery (AICA) aneurysms, a unique aneurysm at the meatal loop inside the internal auditory meatus is extremely rare. The authors report a case of surgically treated total intrameatal AICA aneurysm. A 62-year-old female patient presenting with sudden bursting headache and neck pain was transferred to our department. Computed tomography and digital subtraction angiography showed subarachnoid hemorrhage at the basal, prepontine cistern and an aneurysm of the distal anterior inferior cerebellar artery inside the internal auditory meatus. Surgery was performed by retrosigmoid craniotomy with unroofing of the internal auditory meatus. The aneurysm was identified between the seventh and eighth cranial nerve in the meatus and was removed from the canal and clipped with a small straight Sugita clip. After operation the patient experienced transient facial paresis and tinnitus but improved during follow up.

Keyword

Intrameatal AICA aneurysm; Microsurgery; Facial nerve; Vestibular nerve

MeSH Terms

Aneurysm*
Angiography, Digital Subtraction
Arteries*
Craniotomy
Facial Nerve
Facial Paralysis
Female
Follow-Up Studies
Headache
Humans
Microsurgery
Middle Aged
Neck Pain
Subarachnoid Hemorrhage
Tinnitus
Vestibular Nerve
Vestibulocochlear Nerve

Figure

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  Fig. 1 A : Non-contrast computed tomography showing subarachnoid hemorrhage at right basal, prepontine cistern and intraventricular hemorrhage in the 4th ventricle. B : Contrast enhanced computed tomography showing a right intrameatal enhancing aneurysm (arrow).

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  Fig. 2 Preoperative angiography showing a distal meatal loop anterior inferior cerebellar artery aneurysm.

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  Fig. 3 A : After applying temporary clips to proximal and distal anterior inferior cerebellar artery (white arrow), aneurysm (star) was dissected from between seventh (open white arrow) and eighth (circle) cranial nerve in internal auditory meatus. B : Aneurysm was moved from original position to above eighth cranial nerve as shown in A and clipped with straight clip (white arrowhead; opened internal auditory canal).

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  Fig. 4 Postoperative angiography showing disappearance of aneurysm.

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