Acute Development of a Traumatic Pseudoaneurysm of the Posterior Inferior Cerebellar Artery Due to a Fracture of the Clivus

Abstract

BACKGROUND AND IMPORTANCE: Traumatic intracranial aneurysms are uncommon and are mostly located in the anterior circulation. Aneurysms involving the posterior circulation are extremely rare and account for less than 10% of traumatic aneurysms. In this study, we describe an extremely rare case of a traumatic pseudoaneurysm of the posterior inferior cerebellar artery due to a fracture of the clivus that ruptured in the acute stage after blunt brain injury and that was successfully cured endovascularly. CLINICAL PRESENTATION: A 68-year-old man presented with loss of consciousness because of a severe subarachnoid hemorrhage and multiple contusions after blunt brain injury. Angiography the day after trauma revealed a traumatic pseudoaneurysm near the clivus fracture that had not been identified on the first day of trauma. The aneurysm's location was consistent with the location of the increased thick subarachnoid hemorrhage. The aneurysm was successfully occluded endovascularly through posterior inferior cerebellar artery parent artery occlusion. The patient survived the acute stage because of management that included endovascular treatment followed by decompressive craniectomy. CONCLUSION: A traumatic pseudoaneurysm that is likely to rupture due to the fragility of the aneurysm wall can be identified within 1 day after trauma. Neurosurgeons should pay careful attention to the aneurysm formation and perform early treatment to prevent its rupture, which could lead to a fatal hemorrhage.