Skip to main content

Advertisement

SpringerLink
Log in

Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Aneurysms of the anterior inferior cerebellar artery are rare. Six cases of anterior inferior cerebellar artery (AICA) aneurysms treated at one center are presented. The six cases of AICA aneurysms were surgically treated. The clinical features, surgical process, complications, and follow-up are demonstrated. Six patients with six AICA aneurysms were presented including one AVM accompanied aneurysm and one giant aneurysm. Five aneurysms had ruptured, one was unruptured. Five patients presented with subarachnoid hemorrhage (SAH) including two with intraventricular hemorrhaging and one with an intraparenchymal hematoma. One aneurysm was proximal, two were distal, and three were meatal. All cases were treated surgically. Retrosigmoid and far-lateral craniectomy were included. Navigation was accomplished through intraoperative ultrasound and fluorescent angiography. Resection of the aneurysm after clipping was significant. The most common postoperative deficit involved the cranial nerves in four patients. Follow-up was available for all patients for a mean of 68 months. SAH is the most common presentation. The relationship between the aneurysms and the meatus is an important factor for neurological dysfunction. 3D-CTA and MRA may be considered as diagnostic adjuncts. Several special surgical techniques used in our cases are worth noting. Endovascular therapy for AICA aneurysms is in the process of development and should be reserved for special cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Duvoisin RC, Yahr MD (1965) Posterior fossa aneurysms. Neurology 15:231–241

    PubMed  CAS  Google Scholar 

  2. Investigators International Study of Unruptured Intracranial Aneurysms (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733

    Article  Google Scholar 

  3. McDonald C, Korb M (1939) Intracranial aneurysms. Arch Neurol Psychiatry 42:298–328

    Google Scholar 

  4. Weibel J, Fields WS, Campos RJ (1967) Aneurysms of the posterior cervicocranial circulation: clinical and angiographic considerations. J Neurosurg 26:223–234

    Article  PubMed  CAS  Google Scholar 

  5. Kamano S, Kirino T, Mizuno S (1986) Intrameatal aneurysm. Neurochirurgia (Stuttg) 29:28–30

    CAS  Google Scholar 

  6. Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6368 cases in the cooperative study. J Neurosurg 25:219–239

    Article  PubMed  CAS  Google Scholar 

  7. Locksley HB, Sahs AL, Knowler L (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population. J Neurosurg 24:922–932

    Article  PubMed  CAS  Google Scholar 

  8. Péter B, Sipos L, Vajda J (1996) Aneurysm of the internal auditory artery: our experience and review of the literature. Acta Neurochir (Wien) 138:1157–1162

    Article  Google Scholar 

  9. Chen ZP (1990) Anterior inferior cerebellar artery aneurysm: report of two cases. Zhonghua Wai Ke Za Zhi 28:490–511 [in Chinese]

    PubMed  CAS  Google Scholar 

  10. Crockard HA, Koksel T, Watkin N (1991) Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier: technical note. J Neurosurg 75:483–485

    Article  PubMed  CAS  Google Scholar 

  11. Gruber A, Killer M, Bavinzski G, Richling B (1999) Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery 45:793–803

    Article  PubMed  CAS  Google Scholar 

  12. Ildan F, Gocer AI, Bagdatoglu H, Uzuneyupoglu Z, Tuna M, Cetinalp E (1996) Isolated trigeminal neuralgia secondary to distal anterior inferior cerebellar artery aneurysm. Neurosurg Rev 19:43–46

    Article  PubMed  CAS  Google Scholar 

  13. Kyoshima K, Matsuda M, Handa J (1995) Cerebral aneurysm of the distal anterior inferior cerebellar artery: case report. Nippon Geka Hokan 64:139–145

    PubMed  CAS  Google Scholar 

  14. Lawton MT, Daspit CP, Spetzler RF (1997) Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41:513–521

    PubMed  CAS  Google Scholar 

  15. Mizushima H, Kobayashi N, Yoshiharu S et al (1999) Aneurysm of the distal anterior inferior cerebellar artery at the medial branch: a case report and review of the literature. Surg Neurol 52:137–142

    Article  PubMed  CAS  Google Scholar 

  16. Nader S, Phiroz T, Albert CL, Michael TL (2008) The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular ear. Neurosurgery 62:1236–1253

    Article  Google Scholar 

  17. Nishi S, Taki W, Nakahara I et al (1996) Embolization of cerebral aneurysms with a liquid embolus, EVAL mixture: report of three cases. Acta Neurochir (Wien) 138:294–300

    Article  CAS  Google Scholar 

  18. Oana K, Murakami T, Beppu T, Yamaura A, Kanaya H (1991) Aneurysm of the distal anterior inferior cerebellar artery unrelated to the cerebellopontine angle: case report. Neurosurgery 28:899–903

    Article  PubMed  CAS  Google Scholar 

  19. Saito A, Ezura M, Takahashi A, Yoshimoto T (2000) An arterial dissection of the distal anterior inferior cerebellar artery treated by endovascular therapy. No Shinkei Geka 28:269–274 [in Japanese]

    PubMed  CAS  Google Scholar 

  20. Spallone A, De Santis S, Giuffre R (1995) Peripheral aneurysms of the anterior inferior cerebellar artery: case report and review of the literature. Br J Neurosurg 9:537–541

    Article  PubMed  CAS  Google Scholar 

  21. Suzuki K, Meguro K, Wadw M, Fujita K, Nose T (1999) Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar artery: case report and review of the literature. Surg Neurol 51:509–512

    Article  PubMed  CAS  Google Scholar 

  22. Vincentelli F, Caruso G, Licastro G, Rabehanta P (1998) Association between an aneurysm of the anterior inferior cerebral artery and an arteriovenous malformation fed by the same artery. J Neurosurg Sci 42:41–45

    PubMed  CAS  Google Scholar 

  23. Woischneck D, Hussein S (1991) The anterior inferior cerebellar artery (AICA): clinical and radiological significance. Neurosurg Rev 14:293–295

    Article  PubMed  CAS  Google Scholar 

  24. Drake CG, Peerless SJ, Hernesniemi JA (1995) Surgery of vertebrobasilar aneurysms: London, Ontario experience on 1767 patients. Springer, New York

    Google Scholar 

  25. Gonzalez LF, Alexander MJ, McDougall CG, Spetzler RF (2004) Anteroinferior cerebellar artery aneurysms: surgical approaches and outcomes—a review of 34 cases. Neurosurgery 5:1025–1035

    Article  Google Scholar 

  26. Rhoton AL (2000) The posterior cranial fossa: microsurgical anatomy and surgical approaches. Neurosurgery 47(Suppl):29–68

    Article  Google Scholar 

  27. Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A (2004) Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature. Surg Neurol 1:82–88, discussion 88

    Article  Google Scholar 

  28. Cronqvist S, Troupp H (1996) Intracranial arteriovenous malformation and arterial aneurysm on the same patient. Acta Neurol Scand 42:307–316

    Article  Google Scholar 

  29. Rohde V, Spangenberg P, Mayfrank L, Reinges M, Gilsbach JM, Coenen VA (2005) Advanced neuronavigation in skull base tumors and vascular lesions. Minim Invasive Neurosurg 50:742–749

    Google Scholar 

  30. Akyüz M, Tuncer R (2005) Multiple anterior inferior cerebellar artery aneurysms associated with an arteriovenous malformation: case report. Surg Neurol 64(Suppl 2):S106–S108

    Article  PubMed  Google Scholar 

  31. Drake CG, Friedman AH, Peerless SJ (1986) Posterior fossa arteriovenous posterior fossa arteriovenous. J Neurosurg 64:1–10

    Article  PubMed  CAS  Google Scholar 

  32. Guzman R, Grady MS (1999) An intracranial aneurysm on the feeding artery of a cerebellar hemangioblastoma: case report. J Neurosurg 91:136–138

    Article  PubMed  CAS  Google Scholar 

  33. Kikuchi K, Kamisato N, Sasanuma J, Watanabe K, Kowada M (1990) Trigeminal neuralgia associated with posterior fossa arteriovenous malformation and aneurysm fed by the same artery. Case report. Neurol Med Chir (Tokyo) 30:918–921

    Article  CAS  Google Scholar 

  34. Menovsky T, André GJ, Bartels RH (2002) Aneurysm of the anterior inferior cerebellar artery associated with high-flow lesion: report of two cases and review of literature. J Clin Neurosci 9:207–211

    Article  PubMed  Google Scholar 

  35. Thompson RC, Steinberg GK, Levy RP, Marks MP (1998) The management of patients with arteriovenous malformation and associated intracranial aneurysms. Neurosurgery 43:202–211

    Article  PubMed  CAS  Google Scholar 

  36. Lee SH, Koh JS, Bang JS, Kim GK (2009) A case of ruptured peripheral aneurysm of the anterior inferior cerebellar artery associated with an arteriovenous malformation a less invasive image guided transcortical approach. J Korean Neurosurg Soc 46:577–580

    Article  PubMed  Google Scholar 

  37. Figueiredo EG, Gomes MQ, Brito-Neto RV, Paiva WS, Teixeira MJ (2008) A giant partially thrombosed AICA aneurysm. Arq Neuropsiquiatr 3A:566–568

    Article  Google Scholar 

  38. Pritz MB (1993) Aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien) 120:12–19

    Article  CAS  Google Scholar 

  39. Dalley RW, Robertson WD, Nugent RA, Durity FA (1986) Computed tomography of anterior inferior cerebellar artery aneurysm mimicking an acoustic neuroma. J Comput Assist Tomogr 10:881–894

    Article  PubMed  CAS  Google Scholar 

  40. Zager EL, Shaver EG, Hurst RW, Flamm ES (2002) Distal anterior inferior cerebellar artery aneurysms. Report of four cases. J Neurosurg 3:692–696

    Google Scholar 

  41. Iwanaga S, Shrier DA, Okawara SH, Numaguchi Y (1999) Value of CT angiography in the evaluation of a peripheral anterior inferior cerebellar artery aneurysm: case report. Clin Imaging 23:77–80

    Article  PubMed  CAS  Google Scholar 

  42. Bambakidis NC, Manjila S, Dashti S, Tarr R, Megerian CA (2009) Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature. Neurosurg Focus 26(E6):1–8

    Google Scholar 

  43. Nishimoto A, Fujimoto S, Tsuchimoto S et al (1983) Anterior inferior cerebellar artery aneurysm. Report of three cases. J Neurosurg 59:697–702

    Article  PubMed  CAS  Google Scholar 

  44. Andaluz N, Pensak ML, Zuccarello M (2005) Multiple, peripheral aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien) 4:419–422, discussion 422

    Article  Google Scholar 

  45. Peluso JP, Van Rooij WJ, Sluzewski M, Beute GN (2007) Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular parent vessel occlusion. Am J Neuroradiol 28:1573–1578

    Article  PubMed  CAS  Google Scholar 

  46. Ishii D, Takechi A, Shinagawa K, Sogabe T (2010) Endovascular treatment for ruptured anterior inferior cerebellar artery aneurysm. Neurol Med Chir 50:396–399

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, 100050

    Xin Li, Dong Zhang & Jizong Zhao

Authors
  1. Xin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jizong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jizong Zhao.

Additional information

Comments

Siamak Asgari, Ingolstadt, Germany

The authors reported about six patients with six aneurysms located at the distal portion of the anterior inferior cerebellar artery (AICA). Two patients were presented in details. All patients suffered from spontaneous intracranial hemorrhage. All patients underwent microsurgical treatment via retrosigmoid (n = 4) or far-lateral approach. The clinical results mainly were good with some degree of cranial nerve deficits due to the preoperative symptomatology (facial nerve, vestibulocochlear nerve). However, the clinical data, tables, and figures are of good to excellent quality. Additionally, the authors gave a good review of the literature concerning microsurgical series. In my own experience, AICA aneurysms are very rare. The last two cases I remember, were AVM-associated and treated endovascularly before resection of the residual AVM nidus. In modern management of intracranial vascular malformations, neuro-interventional or endovascular strategies have to be included into the considerations.

William T. Couldwell, Salt Lake City, UT, USA

The authors report on six cases of AICA aneurysms treated at their institution over a recent 8-year period. Five of these eight cases were ruptured at the time of treatment. These aneurysms represented only 0.3% of all of the 1,647 aneurysms treated over this period, which is a testament to the rare nature of developing aneurysms in this location. Add to this fact that there were two cases of unusual lesions among the six (such as one aneurysm associated with a feeding artery to an AVM and a giant fusiform lesion), it is noted that the prevalence of a standard berry aneurysm in this location is very rare indeed. The paper provides a nice description of their clinical presentation and techniques used for surgical management of this series of patients. All of the aneurysms were approached using an open surgery; no endovascular therapy was used. One half of the six aneurysms were meatal in location and the others were post-meatal (two cases) or pre-meatal (one case).

The authors report that cranial nerve deficits were the most common complication. As expected, given the location of these aneurysms, VII and VIII nerve injuries were the most frequent; one half of the patients permanently lost hearing, and all lesions in the meatal location, indicating that this complication is very high for lesions in this location, either caused by rupture of the aneurysm or its surgical treatment. It will be important to see whether the treatment-related cranial nerve injuries will be diminished by evolving endovascular techniques. The authors should be commended on their successful management of this difficult subset of aneurysm patients.

Michael T. Lawton, San Francisco, USA

Dr. Zhao and colleagues describe a clinical series of six patients with AICA aneurysms including an AVM-associated aneurysm and a giant aneurysm. I congratulate the authors on their excellent surgical results. We recently reported a nomenclature for cerebellar arteries that might refine the localization of AICA aneurysms (1). As the authors discuss, the choice between endovascular and microsurgical can be challenging. Aneurysm location along AICA is an important factor. In general, I prefer coiling AICA aneurysms that are proximal at the AICA origin and clipping aneurysms that are more distally located. It has been my experience as well that the retrosigmoid approach adequately exposes these aneurysms without more extensive presigmoidal drilling.

Distal aneurysms can be buried in the canal or draped by the nerves, and an aneurysm’s relationship to the internal auditory meatus should be evaluated carefully preoperatively. Reconstructive techniques with clips or bypass are effective in repairing these often dysmorphic aneurysms with the preservation of AICA circulation.

References

1. Rodriguez-Hernandez A, Rhoton AL Jr., Lawton MT (2011) Segmental anatomy of cerebellar arteries: a proposed nomenclature. J Neurosurg. doi:10.3171/2011.3.JNS101413

Xin Li and Dong Zhang contributed equally to this work as first coauthors.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, X., Zhang, D. & Zhao, J. Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature. Neurosurg Rev 35, 111–119 (2012). https://doi.org/10.1007/s10143-011-0338-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-011-0338-1

Keywords

Search

Navigation