title: Strategies in the treatment of distal cerebellar aneurysms: report of a series of 11 patients.
abstract: BACKGROUND
  Distal cerebellar artery aneurysms are rare entities and treatment modalities technically challenging. In recent years, new therapeutic options have emerged through microsurgical and endovascular means.
  
  
  OBJECTIVE
  Based on a series of 11 cases, we describe combined interdisciplinary treatment strategies and report the outcome in a midterm follow-up interval of 12 months.
  
  
  METHODS
  Collection of clinical case data during acute phase and follow-up including standardized angiographic control intervals during follow-up and assessment of the outcome.
  
  
  RESULTS
  7 of 11 reported cases had flow-related aneurysms based on an underlying arteriovenous malformation (AVM) or dural arteriovenous fistula (DAVF); we found multiple aneurysms in four cases. All patients with flow-related aneurysms presented with subarachnoid hemorrhage (SAH). Only one of four patients in this series without an underlying AVM or DAVF presented with SAH that was attributable to a distal cerebellar aneurysm. In one case, we observed a de novo formation of two flow-associated distal aneurysms (10 years interval). Two patients were treated conservatively, five patients were treated endovascularly, one patient was treated surgically and three patients were treated with combined methods. 9 of 11 patients with initial SAH had a good outcome.
  
  
  CONCLUSIONS
  Distal cerebellar aneurysms associated with AVM or DAVF are rare but characterized by a high risk of hemorrhage. The present series indicates that an experienced interdisciplinary team and the combination of available techniques may lead to a reduction of complications and to a better outcome.
authors.affiliation: Department of Neurosurgery, Klinikum Vest, Recklinghausen, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Harati
authors.forename: Anastasios
authors.initials: A
authors.lastname: Mpotsaris
authors.forename: Frauke
authors.initials: F
authors.lastname: Lohmann
authors.forename: Christian
authors.initials: C
authors.lastname: Loehr
authors.forename: Werner
authors.initials: W
authors.lastname: Weber
authors.forename: Maximilian J A
authors.initials: MJ
authors.lastname: Puchner
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome