Neurointervention.  2023 Mar;18(1):63-66. 10.5469/neuroint.2022.00486.

Novel Superior Cerebellar Artery Aneurysm Coming from a Superior Cerebellar Artery-Posterior Cerebral Artery Anastomotic Branch

• Nguyen AV
• Benardete EA

• KMID: 2539948
• DOI: http://doi.org/10.5469/neuroint.2022.00486

Abstract

A middle-aged patient presented with subarachnoid hemorrhage and was found to have a ruptured superior cerebellar artery (SCA) aneurysm arising from the origin of a rare anastomotic branch between the right SCA and right posterior cerebral artery (PCA). The aneurysm was secured by transradial coil embolization, and the patient made a good functional recovery. This case demonstrates an aneurysm arising from an anastomotic branch between the SCA and PCA, which may represent a remnant of a persistent primordial hindbrain channel. Although variations in basilar artery branches are common, aneurysms rarely can form at the site of seldom- seen anastomoses between the branches of the posterior circulation. The complex embryology of these vessels, which includes anastomoses and the involution of primitive arteries, may have contributed to the development of this aneurysm arising from an SCA-PCA anastomotic branch.

Keyword

Intracranial aneurysm; Superior cerebellar artery; Anatomical variation; Subarachnoid hemorrhage; Embryology

Figure

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  Fig. 1. (A) Computed tomography (CT) of the head demonstrating diffuse subarachnoid hemorrhage. (B) Catheter-based angiography approximately 1 week after presentation with subrachnoid hemorrhage demonstrating an aneurysm (black arrow) arising from the superior cerebellar artery (SCA)-posterior cerebral artery (PCA) anastomotic branch (white arrow). (C) Anterior-posterior view of 3D rotational angiography demonstrates a 4.5 mm×2.5 mm aneurysm that shares a neck with the SCA-PCA branch origin and is posterior to the SCA-branch junction. (D) Posterior-anterior view of 3D rotational angiography provides an alternate view of the aneurysm and the SCA-PCA branch (white arrow). (E) CT angiogram of the head with thick cut maximum intensity projection coronal slice demonstrating the SCA-PCA anastomotic branch (black arrow) and posterior communicating artery (white arrow). The posterior communicating artery is clearly separate from the anastomotic branch and joins the PCA more distally than the branch. (F) Raymond–Roy 1 occlusion of the aneurysm with coils (white arrow); still visible is the anastomotic branch between the SCA and PCA (black arrow). (G) Magnetic resonance imaging (MRI) angiography axial slice demonstrating the position of the coils (white arrow). (H) MRI T2/fluidattenuated inversion recovery axial slice without evidence of ischemia.

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