Aneurysm of the Posterior Inferior Cerebellar Artery: Clinical Features and Surgical Results

Rhim, Jong-Kook,Sheen, Seung-Hun,Oh, Sung-Han,Noh, Jae-Sub,Chung, Bong-Sub The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.37 No.6

Objective: Aneurysms arising from the posterior inferior cerebellar artery(PICA) are uncommon. We review literature on that and surgical results on aneurysmal treatment by choice of surgical approach. Methods: On the basis of radiologic findings & charts, we review retrospectively the surgical results of 12 cases from Mar 1999 to Dec 2003. Results: The mean age of the 12 patients was 55.8(ranged from 36 to 71) and female was predominant (female:male = 8:4). Locations of PICA aneurysms revealed variously(vertebral artery - PICA junction: 8, lateral medullary segment: 2, PICA - anterior inferior cerebellar artery common trunk: 1, telovelomedullary : 1). Surgical approaches & treatments were attempted in 11 cases and embolization was done in 1 case(Far lateral transcondylar or supracondylar approach & clipping: 9, Far lateral transcondylar or supracondylar approach and trapping: 2, suboccipital approach & clipping: 1). The surgical result were 8 of 12 patients were good outcome, 1 of 12 was severely disabled and 3 of 12 were died. Conclusion: First, we choose surgical approach by the laterality of aneurysms and surgical or interventional treatment is attempted as soon as possible. The PICA aneurysm is regarded as having a relatively good surgical outcome without drilling of the posterior arch of the atlas.

전정신경염으로 오인된 PICA 경색 3예

정용원,박으뜸,김혜영,정재윤 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.10

Vestibular neuritis represents as a spinning type of dizines acompanied by nausea, vomiting. Central vertigo such as cerebellar uplies the cerebellum by branching out into superior cerebellar artery, anterior inferior cerebellar artery, and posterior inferior cerebellar artery. The patient had spinning type of vertigo, nausea, vomiting on the day of visit without any otologic symptoms. Only spontaneous nystagmus was observed. After admission, the patients diziness aggravated and emergency brain magnetic resonance imaging was performed. As ess decreased, the folow-up imaging study showed improvement of the infarction, and the patient was discharged. We experienced three cases of PICA infarction presenting as peripheral types of dizzines, and therefore we are reporting the case. (Korean J Otorhinolaryngol-Head Neck Surg 2007 ;50 :941-6)

Dissecting Aneurysm Associated with a Double Origin of the Posterior Inferior Cerebellar Artery Causing Subarachnoid Hemorrhage

Koh, Jun-Seok,Lee, Cheol-Young,Lee, Seung-Hwan,Kim, Gook-Ki The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.51 No.1

Two cases of the posterior fossa dissecting aneurysm associated with a double origin of the posterior inferior cerebellar artery (DOPICA) causing subarachnoid hemorrhage are presented. After observing a relationship between the aneurysm and DOPICA on a three dimensional rotational angiogram (3DRA), the dissecting aneurysms were successfully obliterated by surgical trapping and endovascular internal trapping, respectively. This report warrants suspecting DOPICA of an associating anomaly predisposing to dissecting aneurysm in the vertebral artery-posterior inferior cerebellar artery territory and highlights the role of 3DRA in pretreatment evaluation of unusual aneurysms accompanying a particular anatomical variation.

In Situ Intersegmental Anastomosis within a Single Artery for Treatment of an Aneurysm at the Posterior Inferior Cerebellar Artery : Closing Omega Bypass

Lee, Sung Ho,Choi, Seok Keun The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.58 No.5

A 74-year-old patient was diagnosed with a subarachnoid hemorrhage suspected from a dissecting aneurysm located at the lateral medullary segment of the posterior inferior cerebellar artery (PICA). Because perforators to the medulla arose both proximal and distal to the dissecting segment, revascularization for distal flow was essential. However, several previously reported methods for anastomosis, such as an occipital artery-PICA bypass or resection with PICA end-to-end anastomosis could not be used. Ultimately, we performed an in situ side-to-side anastomosis of the proximal loop of the PICA with distal caudal loops within a single artery, as a "closing omega," followed by trapping of the dissected segment. The aneurysm was obliterated successfully, with intact patency of the revascularized PICA.

외상성 후두개 뇌동맥류 : 증례보고 Case Report

김세중,최순관,배학근,이경석,신원한,윤일규,이인수,변박장 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9

The traumatic intracranial aneurysm within the posterior cranial fossa is extremely rare. The case of a 18-year-old boy who developed and saccular aneurysm lately in the posterior fossa after a blunt head injury is reported. Repeated follow-up angiography demonstrated an saccular aneurysm at the junction of vertebral artery and posterior inferior cerebellar artery. Early brain MRI disclosed neither aneurysm nor mass. Late brain MRI revealed a partially thrombosed saccular aneurysm at the cerebello-pontine angle. Follow-up MRI and angiography is recommended if traumatic aneurysm is suspected.

Isolated Dissecting Posterior Inferior Cerebellar Artery Aneurysm

Park, Young-Mok,Han, In-Bo,Ahn, Jung-Yong The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.41 No.3

Dissecting aneurysms frequently involve the vertebral arteries and their branches, but those involving the posterior inferior cerebellar artery [PICA] and not vertebral artery at all are extremely rare. We present a case of an isolated dissecting aneurysm of the PICA without involvement of vertebral artery. A 54-year-old man presented with dizziness and headache. MR imaging of the brain showed a cerebellar infarction of the left PICA territory. MR angiographic and cerebral angiographic studies revealed a dissecting fusiform aneurysm involving the left proximal PICA. Subsequently, the patient underwent GDC embolization. A postembolization angiogram demonstrated complete obliteration of the aneurysm. In this report, the treatment modalities for this rare condition is described with review of the literature.

The Endovascular Management of Saccular Posterior Inferior Cerebellar Artery Aneurysms

송하헌,원유동,김영주,김범수 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.5

Objective: The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. Materials and Methods: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. Results: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedurerelated morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). Conclusion: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective. Objective: The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. Materials and Methods: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. Results: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedurerelated morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). Conclusion: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective.

소뇌 동정맥 기형을 동반한 후하 소뇌 동맥류의 수술적 치험 : 증례보고 Case Report

정성헌,장석정 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.10

A case of a ruptured aneurysm originating at the proximal portion of the left posterior inferior cerebellar artery and an arteriovenous malformation in the left cerebellar hemisphere fed by the same artery is reported. The coincidental occurrence of these two vascular anomalies within the posterior fossa is uncommon. Aneurysms of the posterior inferior cerebellar artery require special consideration during surgical planning and operation because of the proximity of the posterior inferior cerebellar artery to the brain stem and to the origin of the lower cranial nerves . In our reported case, the aneurysm was located 2.7mm from the midline and 4.7mm from the clivus when measured radiometrically. The operation was carried out with the patient in a three quarter prone position through a left lateral suboccipital approach. Clipping of the neck of the aneurysm and total removal of the arteriovenous malformation were performed successfully in a one-stage operation.

전정신경염으로 오인된 후하소뇌동맥 경색 2예

박태정,한정욱,김도현,김보영 대한이비인후과학회 부산,울산,경남 지부회 2012 임상이비인후과 Vol.23 No.1

Vestibular neuritis is characterized by the acute onset of spinning type of dizziness, nausea and vomiting, in the absence of hearing impairment and tinnitus. Central vertigo such as cerebellar infarction may present with nonspecific symptoms similar to those of peripheral vestibulopathy. It is known for being frequently misdiagnosed, therefore cerebellar infarction may pose a significant diagnostic challenge. Basilar artery supplies the cerebellum by branching out into superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (PICA). We experienced two cases of PICA infarction presenting as vestibular neuritis types of dizziness, and therefore we are reporting the cases.

High-Resolution Contrast-Enhanced 3D-Spoiled Gradient-Recalled Imaging for Evaluation of Intracranial Vertebral Artery and Posterior Inferior Cerebellar Artery in Lateral Medullary Infarction

윤영노,정태섭,안성준,서상현,Ah Young Park 대한자기공명의과학회 2014 Investigative Magnetic Resonance Imaging Vol.18 No.1

Purpose : To determine whether high-resolution contrast-enhanced three dimensional imaging with spoiled gradientrecalled sequence (HR-CE 3D-SPGR) plays a meaningful role in the assessment of intracranial vertebral artery (ICVA) and posterior inferior cerebellar artery (PICA) in lateral medullary infarction (LMI). Materials and Methods: Twenty-five patients confirmed with LMI were retrospectively enrolled with approval by the IRB of our institute, and 3T MRI with HR-CE 3D-SPGR and contrast-enhanced magnetic resonance angiography (CE-MRA) were performed. Two radiologists who were blinded to clinical information and other brain MR images including diffusion weighted image independently evaluated arterial lesions in ICVA and PICA. The demographic characteristics, the area of LMI and cerebellar involvement were analyzed and compared between patients with arterial lesion in ICVA only and patients with arterial lesions in both ICVA and PICA on HR-CE 3D-SPGR. Results: Twenty-two of twenty-five LMI patients had arterial lesions in ICVA or PICA on HR-CE 3D SPGR. However twelve arterial lesions in PICA were not shown on CE-MRA. Concurrent cerebellar involvement appeared more in LMI patients with arterial lesion in ICVA and PICA than those with arterial lesion in ICVA alone (p = 0.069). Conclusion: HR-CE 3D-SPGR can help evaluate arterial lesions in ICVA and PICA for LMI patients.