Onyx embolization of a ruptured anterior inferior cerebellar artery in a neonate

Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review

Intracranial aneurysms (IA) in infants are reportedly rare at 0.5% to 4.5% of all aneurysms. Furthermore, subarachnoid hemorrhage in infants younger than three months are even rarer as it has been reported in approximately 20 cases only till date. A 3-month-old infant with seizures and impaired consciousness was admitted to our hospital. Three-dimensional computed tomography angiography (3D-CTA) revealed a dissecting aneurysm with a maximum diameter of 13 mm in the right M2. Internal trapping using detachable coil were successfully performed, following which he was discharged without significant neurological deficit after one month of onset. Thus, we have reported a rare case of a large ruptured dissecting IA in a 3-month-old infant, in the right middle cerebral artery (MCA), successfully treated with an endovascular therapy, along with a literature review.

Which Patients with Aneurysms Involving the a1-a2 Segment of the Anterior Inferior Cerebellar Artery Would Benefit from Parent Artery Occlusion?

Anterior inferior cerebellar artery (AICA) trunk aneurysms are rare entities. Given the eloquence of the AICA in supplying the cerebellum and brainstem, in theory, sacrifice or occlusion of the a1-a2 segment in lesions involving the AICA may lead to various complications. However, some patients might experience no complication or favorable recovery. The subgroup of patients who would benefit from parent artery occlusion (PAO) among those with aneurysms involving the a1-a2 segment of the AICA remains to be explored. In this report, we present 2 cases of AICA dissecting aneurysms at the a1-a2 segment that were successfully occluded via coiling without postprocedural complications. A comprehensive literature review was also performed on patients with AICA aneurysms with occlusion at the a1-a2 segment. Sixteen patients were identified, and all of the cases had satisfactory outcomes. Of these patients, 11 of 16 (68.75%) had no neurologic deficits, and 5 of 16 (31.25%) had acceptable neurologic deficits. The prognosis was associated with collateral circulation of the AICA, and collateral circulation was discussed. In case of an a1-a2 aneurysm that is hard to occlude without sacrificing the parent artery, careful hemodynamic and morphologic evaluation for collateral flow is warranted. If collateral flow is demonstrated or the aneurysm is flow-related with cerebellar arteriovenous malformation, PAO of the a1-a2 segment can be an acceptable option.