title: Microsurgical management of aneurysms of the superior cerebellar artery - lessons learnt: An experience of 14 consecutive cases and review of the literature.
abstract: OBJECTIVE
  This is a retrospective study from January 2002 to December 2012 analyzing the results of microsurgical clipping for aneurysms arising from the superior cerebellar artery (SCA).
  
  
  METHODS
  All patients with SCA were evaluated with computerized tomography angiography and/or digital subtraction angiography (DSA) prior to surgery. All patients in our series underwent microsurgical clipping and postoperative DSA to assess the extent of aneurysm occlusion. The Glasgow outcome scale (GOS) and the modified Rankin's scale (mRS) were used to grade their postoperative neurological status at discharge and 6 months, respectively.
  
  
  RESULTS
  Fourteen patients had SCA aneurysms (ruptured-9, unruptured-5). There were 10 females and 4 males with the mean age of 47.2 years (median - 46 years, range = 24-66 years). Subarachnoid hemorrhage (SAH) was seen in 11 patients. The mean duration of symptoms was 2.5 days (range = 1-7 days). The WFNS score at presentation was as follows: Grade 1 in 10 cases, II in 2 cases, III in 1 case and IV in 1 case. In the 9 cases with ruptured SCA aneurysm, average size of the ruptured aneurysms was 7.3 mm (range = 2.5-27 mm, median = 4.9 mm). The subtemporal approach was used in the first 7 cases. The extradural temporopolar (EDTP) approach was used in the last 5 cases. Complications include vasospasm (n = 6), third nerve palsy (n = 5) and hydrocephalus (n = 3). Two patients died following surgery. At mean follow-up 33.8 months (median - 25 months, range = 19-96 months), no patient had a rebleed. At discharge 9 (64%), had a GOS of 4 or 5 and 3 (21%) had a GOS of 3. At 6 months follow-up, 10/14 (71%) patients had mRS of 0-2, and 2 (14%) had mRS of 5.
  
  
  CONCLUSIONS
  Aneurysms of the SCA are uncommon and tend to rupture even when the aneurysm size is small (<7 mm). They commonly present with SAH. The EDTP approach avoids complication caused by temporal lobe retraction and injury to the vein of Labbe.
authors.affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Prakash
authors.initials: P
authors.lastname: Nair
authors.affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Dilip
authors.initials: D
authors.lastname: Panikar
authors.affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Anup Parameshwaran
authors.initials: AP
authors.lastname: Nair
authors.affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Parasuraman
authors.initials: P
authors.lastname: Ayiramuthu
authors.affiliation: Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Anoop
authors.initials: A
authors.lastname: Thomas
keywords: Accessory superior cerebellar artery; aneurysm; extradural temporopolar approach; subarachnoid hemorrhage; superior cerebellar artery