Transcircular occlusion of the posterior inferior cerebellar artery aneurysm: a case report

Abstract

Background. Aneurysms of the posterior inferior cerebellar artery are a rare vascular pathology among both intracranial aneurysms and aneurysms of the vertebrobasilar territory. Due to the proximity of the caudal nerves, microsurgical treatment may be accompanied by the development of bulbar disorders, so endovascular occlusion is the method of choice for aneurysms of origin of the posterior inferior cerebellar artery. However, anatomical features in the vertebrobasilar territory and individual characteristics of the aneurysm often make antegrade catheterization of the artery difficult. In such cases, alternative methods should be used, one of which is transcircular access through the posterior communicating artery.Aim. To present the result of endovascular treatment of a patient with complex aneurysm of the posterior inferior cerebellar artery, performed with through a transcirculation approach.Materials and methods. The article analyzes the results of the patient's treatment at the Federal Neurosurgical Center (Novosibirsk) of the Ministry of Health of Russia. Surgical intervention consisted of endovascular occlusion of the aneurysm of the right posterior inferior cerebellar artery with stent-assistance. A specific feature of this case was the acute angle of posterior inferior cerebellar artery discharge from the vertebral artery, which significantly hampered the direct endovascular catheterization of the aneurysm and increased the risks of intraoperative complications. A transcirculation approach through the posterior communicating artery was chosen as an access. After discharge, the patient underwent a follow-up examination 6 months later.Results. Excellent clinical and angiographic results (occlusion classification (RROC - Raymond Roy I) were noted both at the time of the patient's discharge and during follow-up based on the results of control angiograms.Conclusion. The use of transcirculation endovascular access to the proximal aneurysm of the posterior inferior cerebellar artery made it possible to obtain a good result of surgical treatment.