Superior Cerebellar Artery Aneurysm Research Articles

Distal superior cerebellar artery aneurysm in a patient with systemic lupus erythematosus: Case report

BACKGROUND The authors describe a case of ruptured distal superior cerebellar artery (SCA) aneurysm in a patient with systemic lupus erythematosus (SLE). CASE DESCRIPTION A 31-year-old female who had been treated for SLE for 13 years presented with a subarachnoid hemorrhage. Cerebral angiography demonstrated an aneurysm arising from the cisternal portion of the left superior cerebellar artery. The patient underwent early endovascular coil embolization and was discharged from our hospital without neurological deficit. CONCLUSION Aneurysms arising from peripheral segments of cerebellar arteries are rare, and delayed surgical clipping has been recommended for these lesions. In addition, the outcomes of SLE patients with ruptured cerebral aneurysms are reported to be very poor due to the systemic complications of SLE. However, our patient had a favorable outcome with early endovascular treatment for the ruptured aneurysm and with appropriate medical treatment for the accompanying SLE. Therefore, early endovascular coil embolization is worthy of consideration among the options for therapeutic intervention in these conditions.

Late Thromboembolic Events after Treatment of Intracranial Aneurysms with Guglielmi Detachable Coils

P98 Purpose: Thrombo-embolic complications associated with the endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils (GDC) generally occur at the time of the procedure or soon after. The purpose of this report is to determine the frequency of late thrombo-embolic events after GDC. Methods: The records of 189 patients who underwent GDC repair of one or more intracranial aneurysms at our institution were reviewed. The occurence of an ischemic event referrable to a coiled aneurysm was determined by clinical, angiographic, and imaging data. Events occuring within 2 days of the endovascular procedure were considered peri-procedural. Kaplan-Meier analysis of ischemic events over time was performed. Results: Two patients suffered documented thrombo-embolic events. One patient presented 5 weeks after coiling with a transient ischemic attack. Angiography demonstrated thrombus on the surface of the coils at the neck of a large ophthalmic artery aneurysm. The second patient presented with a posterior circulation stroke 4 weeks after coiling of a large superior cerebellar artery aneurysm. Angiography showed no significant proximal disease, with thrombus beginning at the neck of the treated aneurysm and extending out both P1 segments. No intra-procedural problems during the initial coiling had occured with either patient. There was no evidence for protrusion of coils into the parent artery in either patient. Both patients had been receiving daily aspirin (325 mg). One additional patient reporting symptoms suggesting possible ischemics event was evaluated and diagnosed as having atypical migraines. The frequency of a clinical thromboembolic event during the first year after coiling (excluding procedural complications) was 1.1%. Conclusions: Thrombo-embolic events may occur as late as 5 weeks after endovascular treatment of aneurysms with GDC.

上小脳動脈末梢部動脈瘤の臨床像

We report a case of a 71-year-old man who presented a subarachnoid hemorrhage (WFNS grade 1) due to rupture of an aneurysm arising from the hemispheric branch of the superior cerebellar artery (SCA). On the 28th day after admission, the aneurysm was successfully clipped through the infratentorial supracerebellar approach in a Concord position. The patient was discharged with slight cerebellar ataxia 1 month after surgery. We discuss the clinical characteristics of distal SCA aneurysm with a review of literature.

Oculomotor nerve palsy after surgery for upper basilar artery aneurysms.

The goals of this study were to evaluate the relationship between postoperative oculomotor nerve palsy and other clinical factors and to improve preoperative estimations of the risk. Such an evaluation has not been previously described in the literature. Patient records for 77 basilar tip aneurysm cases and 28 basilar superior cerebellar artery aneurysm cases treated between 1981 and 1997 were reviewed. Clinical and radiological parameters were separately analyzed using the chi2 test, and then multiple-regression analysis was used. Postoperative oculomotor palsy occurred in 25 (32%) patients with basilar tip aneurysms and 11 (39%) patients with basilar superior cerebellar artery aneurysms, in addition to 2 patients with basilar tip aneurysms and 3 patients with basilar superior cerebellar artery aneurysms who exhibited oculomotor palsy before surgery. For both type of aneurysms, the size and direction of the aneurysms were closely related to oculomotor nerve palsy. The complication also tended to occur in early surgery cases, in younger patients, and in patients of poor-clinical grade status. In this study, some clinical and radiological factors were found to be associated with postoperative oculomotor nerve palsy.

Ruptured vertebrobasilar aneurysms: frequency of the nonaneurysmal perimesencephalic pattern of hemorrhage on CT scans.

To determine the frequency of the computed tomographic (CT) pattern of nonaneurysmal perimesencephalic subarachnoid hemorrhage in the setting of ruptured posterior fossa aneurysms. Four neuroradiologists independently and retrospectively reviewed cranial CT scans of 169 patients with ruptured vertebrobasilar aneurysms (44 cases of posteroinferior cerebellar artery aneurysm, 20 cases of superior cerebellar artery aneurysm, and 105 cases of basilar-tip aneurysm). The mean frequency of nonaneurysmal perimesencephalic pattern of subarachnoid hemorrhage in ruptured vertebrobasilar aneurysms was 7.1% (48 of 676 readings) among the four readers. The mean frequency of aneurysms with the pattern of hemorrhage for each location was as follows: basilar tip, 9.8% (41 of 420 readings); superior cerebellar artery, 5.0% (four of 80 readings); and posteroinferior cerebellar artery, 0%. In 75% (six of eight) of the cases in which the CT pattern of hemorrhage was deemed compatible by all readers with nonaneurysmal hemorrhage, the clinical presentation was mild. Because ruptured posterior fossa aneurysms manifest with the nonaneurysmal pattern of hemorrhage in approximately 10% of cases, a high degree of suspicion should be maintained even if the pattern of subarachnoid hemorrhage suggests a nonaneurysmal origin and clinical symptoms are mild.

Superior cerebellar artery aneurysms associated with infratentorial arteriovenous malformations

We describe three patients with aneurysms arising from the superior cerebellar artery feeding an arteriovenous malformation (AVM) in the posterior fossa. In one patient the aneurysms resolved following thrombosis of the AVM, suggesting that high flow through the feeding vessel is an etiological factor for aneurysm development. The usual presentation is subarachnoid hemorrhage but the outcome of surgical treatment of these lesions is often poor, suggesting an increasing role for interventional neuroradiology in the future.

Paralysis of fourth cranial nerve due to superior cerebellar artery aneurysm

Paralysis of fourth cranial nerve due to superior cerebellar artery aneurysm

Spontaneous Disappearance of Arteriovenous Fistula Between the Vertebral Artery and Deep Cervical Vein —Case Report—

A 58-year-old female was readmitted with pulsatile tinnitus in the right ear 8 months after subtemporo-occipital transtentorial clipping of a peripheral superior cerebellar artery aneurysm. On examination, she was normal except for pulsatile bruit over the right mastoid region. Angiography showed a fistulous communication between the muscular branches of the right vertebral artery and the deep cervical vein. The incision of the aneurysm surgery was supratentorial, so the only possible cause of the upper cervical arteriovenous (AV) fistula was fine gold acupuncture needles implanted for bronchial asthma 18 years before. The AV fistula disappeared spontaneously after 1 month, possibly because of thrombosis of the affected veins.

Traumatic aneurysm of the superior cerebellar artery

Less than 10% of the 250 reported cases of traumatic intracranial aneurysms have involved the posterior circulation. Traumatic aneurysms of the superior cerebellar artery are extremely rare, with only three cases previously reported. This is the first report of a traumatic superior cerebellar artery aneurysm in which the diagnosis was suggested by computed tomographic scan. The potential for a good outcome suggests the value of early angiography when the history and diagnostic imaging studies suggest the possibility of a traumatic aneurysm.

Traumatic Aneurysm of the Superior Cerebellar Artery: Case Report and Review of the Literature

Abstract Less than 10% of the 250 reported cases of traumatic intracranial aneurysms have involved the posterior circulation. Traumatic aneurysms of the superior cerebellar artery are extremely rare, with only three cases previously reported. This is the first report of a traumatic superior cerebellar artery aneurysm in which the diagnosis was suggested by computed tomographic scan. The potential for a good outcome suggests the value of early angiography when the history and diagnostic imaging studies suggest the possibility of a traumatic aneurysm.

<I>Fusiform Superior Cerebellar Artery Aneurysm Presenting with Contralateral Abducens Nerve Paresis</I>

A 25-year-old female suddenly developed headache and diplopia. On admission, neurological examination revealed neck stiffness and left abducens nerve paresis. A computed tomographic scan suggested subarachnoid hemorrhage. Left vertebral angiogram showed an aneurysm on the anterior pontine segment of the right superior cerebellar artery (SCA) and marked flexion and meandering of the basilar artery to the left. At surgery, an atherosclerotic, fusiform aneurysm was found through the right subtemporal transtentorial approach, and the right SCA was clipped just proximal to the aneurysm. Thirteen cases of SCA aneurysm have been described in the literature, but none was a fusiform aneurysm.

Intracranial Aneurysms with Superior Division Paresis of the Oculomotor Nerve

Five patients with intracranial aneurysms had unilateral ptosis, limitation of supraduction, and normal pupillary reactivity. The most common aneurysm location for superior division paresis of the oculomotor nerve was the superior cerebellar-posterior cerebral artery junction, where aneurysms (3) of the basilar artery compressed and flattened the interpeduncular oculomotor nerve from below. A superior cerebellar artery aneurysm and brain stem infarction affected the intra-axial course of the oculomotor nerve producing superior division paresis. Only an aneurysm of the intracavernous carotid artery resulted in superior division paresis at the expected anatomic site of bifurcation of the oculomotor nerve into its superior and inferior divisions. Because the superior division supplies innervation exclusively to the superior rectus muscle and levator palpebrae, an aneurysm involving this branch does not affect the pupillo-constrictor fibers. Consequently, cerebral angiography should be considered in the initial evaluation of this ocular motor deficit.

脳底動脈瘤の急性期手術

Basilar artery aneurysms are undoubtedly very difficult to treat. In the past, surgery for a basilar artery aneurysm has been avoided in the acute stage, because it is more difficult and more hazardous than in the chronic stage. However, while waiting for an operation, there have been not a few patients who regress to a serious condition, or die, due to rebleeding or vasospasm. We believe that even with basilar artery aneurysms, it is necessary to clip the aneurysm as early as possible in order to prevent rebleeding, and as much as possible, to remove subarachnoid clots in order to prevent vasospasm.Total removal of the clots, however, is not only technically impossible, but also sometimes causes brain damage because of the brain retraction. We have already reported that cisternal irrigation therapy with urokinase (UK) and ascorbic acid (AsA) is considered one of the most effective methods to prevent vasospasm.From these points of view, we have performed surgery in the acute stage (within 72 hours) in the seven cases of basilar aneurysms since 1984. Cisternal irrigation therapy with UK and AsA was used in cases with thick layer subarachnoid clots. Among these seven cases, four were basilar bifurcation aneurysms (BA-bif), two were basilar superior cerebellar artery aneurysms (SCA), and one was a posterior cerebral-posterior communicating artery aneurysm (PCA-Pcom). Two patients were classified as Hunt Kosnik Grade II, three were Grade III, and two were Grade IV. On CT scan, six of the seven cases were in Fisher Group III and their CT numbers were over 60, which suggested a higher probability of vasospasm. Cisternal irrigation therapy with UK and AsA was performed in six of these cases.In all seven acute surgical cases, no symptomatic vasospasm was found. The outcome was as follows: four cases were ADL 1, two were ADL 2 and one died of cerebral infarction after long term retraction of internal carotid artery. The results of these seven cases were similar to those of 14 chronic surgical cases of basilar artery aneurysms. These results can mean that we do not have to avoid surgery in the acute stage of a basilar artery aneurysm if the case is operable.Although the number of our cases is still very small, we recommend surgery in the acute stage, even for basilar artery aneurysms. We also recommend to add an effective prevention method for vasospasm, such as the cisternal irrigation therapy with UK and AsA. Surgery in the acute stage may lead to an over-all better outcome for basilar artery aneurysms.

Peripheral Superior Cerebellar Artery Aneurysm

The patient, a 37-year-old female, was hospitalized with a severe headache. Neurological examination on admission revealed no deficits except for neck stiffness and somnolence. Computed tomography showed a subarachnoid hemorrhage, which was especially prominent in the supracerebellar and quadrigeminal cisterns, but demonstrated no ventriculomegaly. Cerebral angiography on admission revealed no apparent abnormalities, but repeat angiography 8 days later disclosed a saccular aneurysm (2 X 3 mm) arising from the hemispheric branch of the left superior cerebellar artery (SCA). Three days after admission, the patient developed cerebellar dysarthria, which was assumed to be due to vasospasm. On the 24th day after admission, the aneurysm was successfully clipped through the infratentorial-supracerebellar approach. The postoperative course was uneventful and the patient was discharged with no neurological deficit. Nineteen other cases of peripheral SCA aneurysm have been reported in the literature. The presence of this type of aneurysm should be considered in patients who are fairly young and have focal neurological signs, such as third or fourth nerve palsy and/or cerebellar dysfunction. The prognosis for such patients is good, except in cases in which the neurological status is poor at the onset.

Superior cerebellar artery aneurysm presenting as an oculomotor nerve palsy in a child

Superior cerebellar artery aneurysm presenting as an oculomotor nerve palsy in a child

Ocular bobbing with superior cerebellar artery aneurysm

A teen-age girl became comatose after the sudden onset of headache. Initial angiography did not reveal the site of bleeding. The subsequent onset of ocular bobbing directed attention to the region of the pons. Repeated angiography showed an aneurysm of the superior cerebellar artery. At surgery, the fundus of the aneurysm was adherent to the pons and there was a small hematoma within the pons. Ocular bobbing is rare, but is most commonly seen in association with destructive lesions of the pontine tegmentum, and is a useful localizing sign.

Persistent hypoglossal artery associated with superior cerebellar artery aneurysm

✓ An aneurysm at the origin of the superior cerebellar artery in a patient with a primitive hypoglossal artery is reported. Selective catheterization of the primitive artery is described with a brief discussion of the embryogenesis of carotid-basilar anastomoses. Associated findings in previously reported cases of persistent hypoglossal artery are briefly reviewed.