Ruptured aneurysms of the choroidal branches of the posterior inferior cerebellar artery: a review of the literature and a case report.
Aneurysms of the choroidal branches of the posterior inferior cerebellar artery (PICA) are quite rare; only seven such cases have been reported thus far. In this study, we present a very rare case of a ruptured aneurysm of a choroidal branch of the PICA; the aneurysm was exposed by splitting the vermis and resected after proximal arterial ligation. We have also undertaken a thorough review of the literature on aneurysms in choroidal branches of the PICA, focusing on the clinical presentation, etiology, radiological findings, and surgical strategies. We found that the aneurysms in our patient and the aneurysms in seven published case reports were small, and frequently associated with vascular anomalies. Intraventricular hemorrhage (IVH) in the fourth ventricle was detected in all eight cases. The outcomes of surgical treatment were generally favorable, notwithstanding the high incidence of rebleeding after rupture of distal PICA aneurysms. The recognition of predominant fourth ventricular hemorrhage should raise the suspicion of the presence of an underlying aneurysm, and digital subtraction angiograms (DSAs) should be immediately obtained in order to detect small aneurysms of the choroidal branches of the PICA.
Hokari
Masaaki
M
Sapporo Asabu Neurosurgical Hospital, Higashi-ku, Sapporo 007-0840, Japan. karimasa@med.hokudai.ac.jp
Kuroda
Satoshi
S
Yasuda
Hiroshi
H
Iwasaki
Motoyuki
M
Abe
Satoru
S
Saitoh
Hisatoshi
H
D000368:Aged; D002531:Cerebellum / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002831:Choroid Plexus / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D020546:Fourth Ventricle / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D014656:Vascular Surgical Procedures; D014696:Ventriculostomy; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology