J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):276-280. 10.7461/jcen.2016.18.3.276.

Fusiform Superior Cerebellar Artery Aneurysm Treated with Endovascular Treatment

• Jeon JB
• Oh SY
• Hyun DK
• Shim YS

• KMID: 2355654
• DOI: http://doi.org/10.7461/jcen.2016.18.3.276

Abstract

An aneurysm of the distal superior cerebellar artery (SCA) is a highly rare disease. Fusiform aneurysms of the distal SCA are particularly challenging to treat. Clipping, trapping with or without bypass using microsurgery or endovascular treatment (EVT) were used to treat this condition. We describe the case of fusiform distal SCA aneurysms treated successfully with endovascular coiling with a 3-month follow-up. A 39 year-old male was presented with subarachnoid hemorrhage (SAH) and a 15 mm fusiform aneurysm of the ambient segment of the left distal SCA. EVT for parent artery occlusion and packing of the aneurysm was done. Left sixth nerve palsy appeared after 1 day of EVT. The symptom completely recovered within 1 week of the post-procedural period. No neurological deficit was seen during the clinical 3-month follow-up. EVT of fusiform distal SCA aneurysms with coils is a safe and feasible option to manage this rare condition. However, the treatment options must be carefully selected depending on the neurologic condition, development of collateral circulation, and configuration of the dissection.

Keyword

Endovascular techniques; Intracranial aneurysm; Subarachnoid hemorrhage

MeSH Terms

Abducens Nerve Diseases
Aneurysm*
Arteries*
Collateral Circulation
Endovascular Procedures
Follow-Up Studies
Humans
Intracranial Aneurysm
Male
Microsurgery
Parents
Rare Diseases
Subarachnoid Hemorrhage

Figure

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  Fig. 1 (A) Brain computed tomography (CT) image. The brain CT shows a Fisher Grade III SAH in the pre-pontine, left ambient and quadrigeminal cistern. (B) Brain computed tomography angiography (CT angiography) image. The brain CT angiography shows fusiform dilatation of the left distal SCA. SAH = subarachnoid hemorrhage; SCA = superior cerebellar artery.

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  Fig. 2 Digital subtraction angiography (DSA) images. The DSA images show the fusiform aneurysm of the left superior cerebellar artery. There was sufficient collateral circulation from the ipsilateral AICA and PICA. AICA = anterior inferior cerebellar artery; PICA = posterior inferior cerebellar artery.

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  Fig. 3 Pre-operative 3-dimensional (D) CT angiography (left) and post-operative 3D DSA images (right). The 3D CT angiography reveals fusiform dilatation of the left distal SCA (left). The 3D DSA shows complete occlusion of the aneurysm sac and involved the distal SCA branch. The ipsilateral duplicated SCA is intact. CT = computed tomography; DSA = digital subtraction angiography; SCA = superior cerebellar artery.

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  Fig. 4 Diffusion weighted images (DWIs) 1 day post-treatment. The DWIs show scattered high signal change, suggesting acute infarction on the left posterior tegmentum, superior vermis, and superior part of the left cerebellum.

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