Thrombosed Posterior Inferior Cerebellar Artery Aneurysm Mimicking a Medulla Oblongata Cavernous Malformation: 2-Dimensional Operative Video.

Abstract

The incidence of posterior inferior cerebellar artery (PICA) aneurysms is estimated to be between 0.5% and 3% of total aneurysm cases.1 Most patients with these aneurysms typically present with subarachnoid hemorrhage, although there are instances in which patients may present with symptoms resulting from mass effect exerted on the brain stem or lower cranial nerves.1,2 Treatment options for PICA aneurysms include endovascular procedures, surgical clipping, or bypass techniques.2 Surgical treatment is considered more effective for partially thrombosed aneurysms compared with endovascular approaches.3 In addition, endovascular coiling of these aneurysms carries the potential risk of coil migration and subsequent reopening of the aneurysm lumen.4 In certain instances, thrombosed PICA aneurysms have the potential to simulate the radiological characteristics of alternative pathologies, such as cavernous malformations or brainstem tumors.5-7 This situation can result in misdiagnosis and inappropriate management. We present the case of a patient who exhibited symptoms of imbalance and dysfunction in the lower cranial nerves. Magnetic resonance imaging findings indicated a possible cavernous malformation in the medulla oblongata. However, further investigation revealed that the underlying cause was a thrombosed PICA aneurysm. The patient was successfully treated through surgical clipping. The patient consented to the procedure and to the publication of his/her image.