title: Dissecting peripheral superior cerebellar artery aneurysms: Report of two cases and review of the literature.
abstract: BACKGROUND
  Only a limited number of dissecting aneurysms of the peripheral cerebellar arteries have been previously described, and very few of these cases involve the superior cerebellar artery (SCA). Due to the rarity of these lesions, there is little consensus regarding prognosis and management. We describe our experience with two cases of complex peripheral SCA dissecting aneurysms and review the existing literature on this fascinating entity.
  
  
  METHODS
  Two patients, both with SCA dissecting aneurysms not amenable to endovascular treatment underwent microsurgical clipping, one with the associated removal of a tentorial meningioma. In each procedure a combined subtemporal, presigmoidal approach was performed. Surgical clips were utilized to reconstruct the aneurysms, and both patients were discharged without complication. Surgical management of complex distal SCA fusiform aneurysm is challenging and options include wrap/clip reconstruction, proximal occlusion, trapping, and distal outflow occlusion. When possible, preservation of the parent artery is preferred to mitigate the risk of brainstem infarction. If proximal occlusion or trapping are employed, we have advocated for the use of combined distal revascularization techniques to prevent permanent ischemic damage of the brainstem and cerebellar hemisphere.
  
  
  CONCLUSIONS
  Peripherally dissecting aneurysm of the SCA is an uncommon entity. Management of these lesions is best handled by an experienced neuro-endovascular team combined with a neurovascular surgeon skilled in skull base approaches.
authors.affiliation: National Brain Aneurysm Center, St. Joseph's Hospital, St. Paul, MN, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Nussbaum
authors.forename: Archie
authors.initials: A
authors.lastname: Defillo
authors.forename: Andrea
authors.initials: A
authors.lastname: Zelensky
authors.forename: Richard
authors.initials: R
authors.lastname: Stoller
authors.forename: Leslie
authors.initials: L
authors.lastname: Nussbaum