Aneurysms arising from the cortical segment of the superior cerebellar artery--two case reports

Distal Parent Vessel Occlusion of 2 Superior Cerebellar Artery Fusiform Aneurysms: Report of 2 Cases and Literature Review

Background

Fusiform superior cerebellar artery (SCA) aneurysms are rare, and their management represents a technical challenge. In complex aneurysms, endovascular parent vessel occlusion of the SCA may be a treatment option. Here, we present 2 cases of fusiform SCA aneurysms, 1 ruptured and 1 unruptured, as well as our institution's management with parent vessel occlusion. We also provide a review of the literature.

Cases Description

Case 1: A 42-year-old male was transferred from an outside hospital with subarachnoid hemorrhage. On admission, the patient had a Glasgow Coma Scale score of 8, a Hunt and Hess grade 4, and a Fisher grade 4. A diagnostic angiogram demonstrated a right SCA fusiform lesion with proximal and distal dilatations of 1.45 mm and 5.35 mm long, respectively, likely representing a single dissecting pseudoaneurysm. The distal dilatation was coiled, resulting in parent vessel occlusion. The patient recovered clinically and was discharged in stable condition.

Case 2: A 27-year-old female was transferred from an outside hospital due to a brainstem stroke. A diagnostic angiogram revealed an S2/S3 segment left SCA fusiform lesion, likely representing a dissecting aneurysm. The patient was neurologically intact at admission and managed conservatively. At the 2-month follow-up angiogram, the dissection had extended along the length of the SCA. Consequently, the patient underwent coil embolization of the distal left SCA. At the 6-month follow-up, the vessel remained obliterated and the patient's neurologic status had improved.

Conclusions

Endovascular coil embolization of fusiform SCA aneurysms offers a reasonable and safe treatment approach.

Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

BACKGROUND

Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it.

CASE DESCRIPTION

The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA) in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA) and SCA and had an uneventful recovery.

CONCLUSIONS

Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

Aneurysm arising from the cortical segment of the superior cerebellar artery: a case report and review of the literatures

BACKGROUND

Aneurysms arising from the distal portion of the SCA are relatively rare. A case is presented of an aneurysm arising from the cortical segment of the SCA.

CASE DESCRIPTION

A 45-year-old woman was admitted to our institution because of severe headache. Radiological examination revealed SAH caused by rupture of the aneurysm located in the cortical segment of the SCA and was treated successfully with coil embolization.

CONCLUSIONS

This type of aneurysms may be difficult to treat surgically because of its inaccessibility and of the common difficulty in preserving the involved parent artery. In view of the previously reported cases, these peripheral aneurysms of the SCA often have undefinable necks, as is shown in our case, which makes a reconstructive endovascular and/or surgical technique more or less difficult. However, the overall outcome is almost always favorable, even if surgical treatment results in proximal parent artery occlusion or trapping with surgical clips. These results imply that an equivalent endovascular approach to these rare lesions can be an effective alternative method of management.

Superior cerebellar artery aneurysms treated using the sole stenting approach

✓Endovascular treatment of intracranial aneurysms has evolved since the introduction of detachable coils. Sole stenting is a brand-new technique that has recently emerged as a definitive treatment for saccular or fusiform aneurysms at particular locations. Superior cerebellar artery aneurysms are rare, and few treated cases have been reported. Most of them have been treated surgically, and endovascular cases usually have been managed with occlusion of the parent vessel. The authors report on the first two endovascularly treated cases with complete cure of the aneurysm as well as preservation of the parent vessel and distal circulation via the sole stenting technique. The results together with several aspects of the technique, such as the correction of the angle of the vessel and modification of the shear stress, are discussed.

Fusiform aneurysm of the superior cerebellar artery: short review article

Fusiform superior cerebellar artery (SCA) aneurysms are quite rare and only 9 cases have been reported in the literature. Fusiform aneurysms are a small group of cerebral aneurysms among the most difficult to treat. The therapeutic approaches in the limited number cited in the literature include surgery and endovascular occlusion. Surgical techniques which have been used are parent artery occlusion, trapping or body clipping of the bleeding site, and wrapping for fusiform aneurysms. Neurological condition, presence of collateral circulation, type and configuration of the aneurysm, and type of the dissection are important factors that predict the course of fusiform SCA aneurysms. We reviewed the literature on fusiform aneurysm of the SCA and report a further case treated surgically.