Skip to main content
SpringerLink
Log in

Idiopathic aneurysms of distal cerebellar arteries: endovascular treatment after rupture

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Idiopathic ruptured aneurysms of distal cerebellar arteries (DCAAs) are rare, and their endovascular therapy (EVT) has as yet not been extensively reported. They are usually assumed to result from local arterial wall disruption rather than infection, unlike distal supratentorial artery aneurysms. This study was performed to audit their frequency, potential aetiology and results of EVT.

Patients and methods

Using strict inclusion criteria and a database of 1715 EVT patients, we identified ten idiopathic ruptured DCAAs (0.6%) over a 13-year period (1993–2006). The series comprised six males and four females with mean age of 64 years and solitary aneurysms located on posterior inferior cerebellar artery (five patients), anterior inferior cerebellar artery (three patients) and superior cerebellar artery (two patients). Nine aneurysms were fusiform and were treated by endovascular parent artery occlusion, and one was saccular and treated by endosaccular packing. Endovascular therapy was performed with coils in seven cases, n-butyl-2-cyanoacrylate (NBCA) in two cases and with both in one case.

Results

Primary EVT was successful in eight patients. One patient died following a procedure-related re-bleeding and one patient required re-treatment after failed endosaccular packing. Nine patients made good or excellent clinical recoveries (modified Rankin Scale 2 or less). Focal cerebellar infarctions were seen on computed tomography images after EVT in three patients, only one of whom was symptomatic with transient dysmetria, which resolved completely during follow up. No aneurysm recanalisation was detected on late follow-up imaging up to 24 months.

Conclusion

Ruptured DCAAs are rare. The majority are fusiform in shape and their aetiology remains uncertain. Endovascular treatment is feasible and effective. It usually requires parent artery occlusion.

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

Similar content being viewed by others

References

  1. Khayata MH, Aymard A, Casasco A, Herbreteau D, Woimant F, Merland JJ (1993) Selective endovascular techniques in the treatment of cerebral mycotic aneurysms. J Neurosurg 78:661–665

    PubMed  CAS  Google Scholar 

  2. Cockrill HH Jr, Jimenez JP, Goree JA (1977) Traumatic false aneurysm of the superior cerebellar artery simulating posterior fossa tumor. Case report. J Neurosurg 46:377–380

    PubMed  Google Scholar 

  3. Mabuchi S, Kamiyama H, Abe H (1992) Distal aneurysms of the superior cerebellar artery and posterior inferior cerebellar artery feeding an associated arteriovenous malformation: case report. Neurosurgery 30:284–287

    Google Scholar 

  4. Vincentelli F, Caruso G, Licastro G, Rabeanta 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 

  5. Gacs G, Vinuela F, Fox AL, Drake CG (1983) Peripheral aneurysms of the cerebellar arteries. J Neurosurg 58:63–68

    PubMed  CAS  Google Scholar 

  6. Locksley HB (1966) Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Haeomarrhage. Section V, Part I. Natural history of subarachnoid haemorrhage, intracranial aneurysms and arteriovenous malformations based on 6368 cases in the Cooperative Study. J Neurosurg 25:219–239

    PubMed  CAS  Google Scholar 

  7. Fukuya T, Kishikawa T, Ikeda J, Kudo S, Kuwano H, Matsumoto S, Fujii K (1987) Aneurysms of the peripheral portion of the anterior inferior cerebellar artery; report of two cases. Neuroradiology 29:493–496

    Article  PubMed  CAS  Google Scholar 

  8. Kurosu A, Fuji T, Ono G (2000) Distal superior cerebellar aneurysms. Br J Neurosurg 14:244–246

    Article  PubMed  CAS  Google Scholar 

  9. 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 

  10. Nishizaki T, Tamaki N, Nishida Y, Fujita K, Matsumoto S (1985) Aneurysms of the distal posterior inferior cerebellar artery: experience with three cases and review of the literature. Neurosurgery 16:829–832

    Article  PubMed  CAS  Google Scholar 

  11. Zager EL, Shaver EG, Hurst RW, Flamm ES (2002) Distal anterior inferior cerebellar artery aneurysms: report of four cases. J Neurosurg 97:692–696

    Article  PubMed  Google Scholar 

  12. Anegawa S, Hayashi T, Torigoe R, Nakagawa S, Furukawa Y, Tomokiyo M (2001) Aneurysms of the distal posterior inferior cerebellar artery-analysis of 14 aneurysms in 13 cases. No Shinkei Geka 29:121–129

    PubMed  CAS  Google Scholar 

  13. Horiuchi T, Tanaka Y, Hongo K, Nitta J, Kusano Y, Kobayashi S (2003) Characteristics of distal posteroinferior cerebellar artery aneurysms. Neurosurgery 53:589–595

    Article  PubMed  Google Scholar 

  14. Lewis S, Chang DJ, Peace DA, Lafrentz PJ, Day AL (2002) Distal posterior inferior cerebellar artery aneurysms: clinical features and management. J Neurosurg 97:756–766

    PubMed  Google Scholar 

  15. Orakcioglu B, Schuknecht B, Otani N, Khan N, Imhof HG, Yonekawa (2005) Distal posterior inferior cerebellar artery aneurysms: Clinical characteristics and surgical management. Acta Neurochirurg (Vienna) 147:1131–1139

    Article  CAS  Google Scholar 

  16. Bradac GB, Bergui M (2004) Endovascular treatment of the posterior inferior cerebellar artery aneurysm. Neuroradiology 46:1006–1011

    Article  PubMed  CAS  Google Scholar 

  17. Chaloupka J, Putman C, Awad I (1996) Endovascular therapeutic approach to peripheral aneurysms of the superior cerebellar artery. AJNR Am J Neuroradiol 17:1338–1442

    PubMed  CAS  Google Scholar 

  18. Cognard C, Weill A, Tovi M, Castaings L, Rey A, Moret J (1999) Treatment of distal aneurysms of the cerebellar arteries by intraaneurysmal injection of glue. AJNR Am J Neuroradiol 20:780–784

    PubMed  CAS  Google Scholar 

  19. Mukonoweshuro W, Laitt RD, Hughes DG (2003) Endovascular treatment of PICA aneurysms. Neuroradiology 45:188–192

    PubMed  CAS  Google Scholar 

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

    Google Scholar 

  21. Andreou A, Ioannidis I, Mitsos A (2007) Endovascular treatment of peripheral intracranial aneurysms. AJNR Am J Neuroradiol 28:355–361

    PubMed  CAS  Google Scholar 

  22. Biondi A, Jean B, Vivas E et al. (2006) Giant and large peripheral cerebral aneurysms: etiopathologic considerations, endovascular treatment, and long-term follow-up. AJNR Am J Neuroradiol 27:1685–1692

    PubMed  CAS  Google Scholar 

  23. Cloft H, Kallmes D, Jensen M, Lanzino G, Dion J (1999) Endovascular treatment of ruptured, peripheral cerebral aneurysms: parent artery occlusion with short Guglielmi detachable coils. AJNR Am J Neuroradiol 20:308–310

    PubMed  CAS  Google Scholar 

  24. Eckard D, O’Boynick P, McPherson C et al (2000) Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms. AJNR Am J Neuroradiol 21:137–142

    PubMed  CAS  Google Scholar 

  25. Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP (2003). Endovascular treatment of peripheral cerebellar artery aneurysms. AJNR Am J Neuroradiol 24:1208–1213

    PubMed  Google Scholar 

  26. Maimon S, Saraf-Lavi E, Rappaport ZF, Bachar G (2006) Endovascular treatment of isolated dissecting aneurysm of the posterior inferior cerebellar artery. AJNR Am J Neuroradiol 27:527–532

    PubMed  CAS  Google Scholar 

  27. Sohn MJ, Byrne JV (2000) A computerised relational database for auditing endovascular treatment of patients with intracranial aneurysms. Neuroradiology 42:762–765

    Article  PubMed  CAS  Google Scholar 

  28. Lister JR, Rhoton A, Matsuhima T, Peace DA (1982) Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery 10:170–199

    Article  PubMed  CAS  Google Scholar 

  29. Drake CG, Hunt WE, Sano K et al. (1988) Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid haemorrhage grading scale. J Neurosurg 68:985–986

    Google Scholar 

  30. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9

    Article  PubMed  CAS  Google Scholar 

  31. Drake CG (1979) The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96–144

    PubMed  CAS  Google Scholar 

  32. Holmes B, Harbaugh RE (1993) Traumatic intracranial aneurysms: a contemporary review. J Trauma 35:855–860

    PubMed  CAS  Google Scholar 

  33. Kunze S, Schiefer W (1971) Angiographic demonstration of a dissecting aneurysm of the middle cerebral artery. Neuroradiology 2:201–206

    Article  PubMed  CAS  Google Scholar 

  34. Proust F, Callonec F, Bellow F et al. (1997) Tentorial edge traumatic aneurysm of the superior cerebellar artery. Case report. J Neurosurg 87:950–954

    PubMed  CAS  Google Scholar 

  35. Heros R (2002) Posterior inferior cerebellar artery. Editorial. J Neurosurg 97:747–748

    PubMed  Google Scholar 

  36. Biondi A (2006) Trunkal intracranial aneurysms. Dissecting and fusiform aneurysms. Neuroimaging Clin N Am 16:453–465

    Article  PubMed  Google Scholar 

  37. Day AL, Gaposchkin G, Yu CJ, Rivet D, Dacet RG (2003) Spontaneous fusiform middle cerebral artery aneurysms characteristics and a proposed mechanism of formation. J Neurosurg 99:228–240

    PubMed  Google Scholar 

  38. Kitanaka C, Sasaki T, Eguchi T, Teraoka A, Nakane M, Hoya K (1994) Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627

    Article  PubMed  CAS  Google Scholar 

  39. Shimoji T, Bando K, Nakajima K, Ito K (1984) Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61:1038–1046

    Article  PubMed  CAS  Google Scholar 

  40. Berger MS, Wilson CB (1984) Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894

    PubMed  CAS  Google Scholar 

  41. Schievink WI, Wijdicks EF, Piepgras DG, Chu-Pin Chu, O’Fallon M, Whisnant JP (1995) The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. J Neurosurg 82:791–795

    PubMed  CAS  Google Scholar 

  42. Beyerl BD, Heros RC (1986) Multiple peripheral aneurysms of the posterior inferior cerebellar artery. Neurosurgery 19:285–289

    Article  PubMed  CAS  Google Scholar 

  43. Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach, part 2. Preliminary clinical experience. J Neurosurg 77:515–524

    Google Scholar 

  44. International Subarchnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascularcoiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274

    Google Scholar 

  45. Lempert TE, Malek AM, Halbach VV et al. (2000) Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes. Stroke 31:100–110

    PubMed  CAS  Google Scholar 

  46. Weaver JP, Fisher M (1994): Subarachnoid aneurismal haemorhage: an update of pathogenesis, diagnosis and management. Journal of Neurol Science 125: 119-131

    Article  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Radcliffe Infirmary, Oxford, UK

    A. P. Mitsos, R. A. Corkill, S. Lalloo, W. Kuker & J. V. Byrne

Authors
  1. A. P. Mitsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. A. Corkill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Lalloo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Kuker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. V. Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. P. Mitsos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mitsos, A.P., Corkill, R.A., Lalloo, S. et al. Idiopathic aneurysms of distal cerebellar arteries: endovascular treatment after rupture. Neuroradiology 50, 161–170 (2008). https://doi.org/10.1007/s00234-007-0315-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-007-0315-0

Keywords

Search

Navigation