Distal Aneurysms of Cerebellar Arteries: Incidence, Clinical Presentation, and Outcome of Endovascular Parent Vessel Occlusion

J.P.P. Peluso; W.J. van Rooij; M. Sluzewski; G.N. Beute

doi:10.3174/ajnr.A0607

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Fig 1.
A 59-year-old woman with isolated right trochlear nerve palsy. A, MR image demonstrates a partially thrombosed aneurysm lateral to the brain stem. B, A 3D angiogram shows a distal SCA aneurysm (arrow). C, Detail of the 3D angiogram reveals an aneurysm without a neck (double arrow) on the rostral trunk of SCA (arrow).
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Fig 2.
A 68-year-old woman with hemorrhage from a distal SCA aneurysm. A, CT scan shows subarachnoid and intraventricular blood and vermian hematoma. B, A 3D angiogram demonstrates a fusiform aneurysm of the caudal trunk of the SCA (small arrow). Also a small AVM is apparent (large arrow). C and D, Angiograms before (C) and after (D) occlusion of the aneurysm and parent vessel with coils.
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Fig 3.
A 69-year-old woman with hemorrhage from a distal AICA aneurysm. A, A right vertebral angiogram shows a small distal AICA aneurysm (arrow). B, Detail of 3D right vertebral angiogram shows a distal AICA aneurysm without a neck. C, A microcatheter in the AICA just proximal to the aneurysm. The AICA was occluded with coils at this level.
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Fig 4.
A 57-year-old woman with hemorrhage from a distal PICA aneurysm. A, A 3D angiogram demonstrates an aneurysm on the medial cortical branch of the right PICA (arrow), supplying a small torcular AVM, not well demonstrated in this threshold setting (circle). The aneurysm was occluded with coils, including the parent vessel. B, CT scan after 2 weeks reveals infarction in the medial territory of the right PICA.

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Clinical, imaging, and treatment characteristics of 11 patients with 13 distal cerebellar artery aneurysms

Patient No./Sex/Age	Presentation	Aneurysm Location	Additional Vascular Disease	Timing (days)	Treatment	Outcome	Duration of Follow-Up (months)
1/F/59	Trochlear nerve palsy	SCA rostral trunk	None		Coil occlusion aneurysm + SCA rostral branch	No infarction on MRI, trochlear nerve palsy, improved	12
2/F/68	SAH + IVH, vermian hematoma, HH IV	SCA caudal trunk	AVM cerebellum	1	EVD, coil occlusion aneurysm + SCA caudal branch, γ-knife for AVM scheduled	Partial SCA infarction on MRI, independent	2
3/M/70	SAH +IVH, HH II	SCA rostral trunk	AVM cerebellum	1	Coil occlusion aneurysm + SCA rostral branch, later γ-knife AVM	No infarction on MRI, independent	39
4/M/45	SAH + IVH, HH II, facial palsy and hearing loss	AICA rostral branch	MCA aneurysm coiled	4	Coil occlusion aneurysm + AICA rostral branch	No infarction on MRI, persistent facial palsy and hearing loss, independent	30
5/F/44	SAH + IVH, HH III, facial palsy and hearing loss	AICA main stem	None	4	EVD, coil occlusion aneurysm + AICA main stem	Infarction brachium pontis, persistent facial palsy and hearing loss, independent	8
6/M/63	SAH + IVH, HH III, facial palsy and hearing loss	AICA main stem	AVM cerebellum	3	EVD, coil occlusion aneurysm + AICA main stem, later γ-knife AVM	Infarction brachium pontis, persistent facial palsy and hearing loss, independent	6
7/F/69	SAH + IVH, HH IV	AICA main stem	None	1	EVD, coil occlusion aneurysm + AICA main stem	No infarction on MRI, independent at discharge, sudden death after 2 months, no cause at autopsy, no infarction AICA territory	2
8/M/64	SAH + IVH, HH IV	AICA main stem, PICA cortical segment	AVM cerebellum	3	EVD, coil occlusion aneurysms + AICA main stem/PICA main stem, later γ-knife AVM	No infarction on MRI, independent	40
9/F/57	SAH + IVH, vermian hematoma, HH IV	PICA medial cortical segment	AVM cerebellum	14	EVD, coil occlusion aneurysm + PICA medial branch, later γ-knife AVM	Medial PICA infarction on CT, no gait imbalance, independent	15
10/M/70	2 × SAH + IVH, HH V	2 × PICA cortical segment	AVM cerebellum	6	EVD, glue occlusion PICA cortical segment, later surgery for AVM	No infarction on MRI, independent	24
11/M/66	2 × SAH + IVH, HH V, exploratory surgery negative for aneurysm	PICA cortical segment	None	12	EVD, coil occlusion aneurysm + PICA segment	Partial PICA infarction on CT, dependent in nursing home, died 4 months later of pneumonia	4

Note:—EVD indicates external ventricular drainage; SAH, subarachnoid hemorrhage; IVH, intraventricular hemorrhage; HH, Hunt and Hess scale; MCA, middle cerebral artery; MRI, MR imaging; SCA, superior cerebellar artery; AVM, arteriovenous malformation.