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AJNR - American Journal of Neuroradiology

Published ahead of print on October 10, 2007
doi: 10.3174/ajnr.A0758

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Posterior Inferior Cerebellar Artery Aneurysms: Incidence, Clinical Presentation, and Outcome of Endovascular Treatment

J.P. Peluso^a, W.J. van Rooij^a, M. Sluzewski^a, G.N. Beute^b and C.B. Majoie^c

^a Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
^b Department of Neurosurgery, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
^c Department of Radiology, Academisch Medisch Centrum, Amsterdam, the Netherlands

View larger version (169K): [in this window] [in a new window]   Fig 1. A 49-year-old man presenting with left abducens and right facial nerve palsies. A, MR imaging demonstrates an aneurysm compressing the medulla and pons with surrounding edema. B, Left vertebral angiogram shows a PICA aneurysm. C, After coiling, complete aneurysm occlusion is seen. D, MR imaging 6 months later shows regression of edema; cranial nerve palsies are cured.

View larger version (59K): [in this window] [in a new window]   Fig 2. A 52-year-old woman with an incidentally found PICA aneurysm. A, 3D left vertebral angiogram demonstrates PICA aneurysm with the PICA originating from the sac. B, Six-month follow-up angiogram shows complete occlusion with preservation of flow in the PICA.

View larger version (59K): [in this window] [in a new window]   Fig 3. Ruptured PICA aneurysm in a 62-year-old man presenting in poor clinical condition. A, 3D right vertebral angiogram shows a wide-necked PICA aneurysm. This aneurysm was treated with coil occlusion, including the parent PICA (internal trapping). B, CT scan 6 months later demonstrates infarction in the PICA territory; however, the patient was asymptomatic.

View larger version (72K): [in this window] [in a new window]   Fig 4. Acutely ruptured PICA aneurysm in a 46-year-old woman. A, 3D left vertebral angiogram shows PICA aneurysm broad-based on the VA and PICA, originating from the sac. B, Angiography in the process of coiling, with occlusion of the PICA including the VA and PICA origin. MR imaging 3 months later (not shown) revealed small bilateral peripheral asymptomatic cerebellar infarctions, probably as a result of vasospasm.

View larger version (132K): [in this window] [in a new window]   Fig 5. A 68-year-old woman presenting 18 days after SAH from PICA aneurysm. A, Right vertebral angiogram demonstrates PICA aneurysm with PICA originating from the sac. B, Left vertebral angiogram after coil occlusion of the right VA proximal to the PICA (arrow) demonstrates persistent opacification of the aneurysm. MR imaging 6 months later (not shown) was equivocal for aneurysm thrombosis; there was no recurrent hemorrhage during 7 years of clinical follow-up.

View larger version (146K): [in this window] [in a new window]   Fig 6. A 71-year-old woman presenting with acute SAH in poor clinical condition. A, 3D right vertebral angiogram shows broad-based PICA aneurysm with PICA originating from the sac. B, Right vertebral angiogram after coil occlusion of the aneurysm and coil and balloon occlusion of the right VA. C and D, MR imaging 2 weeks later shows right lateral medullary infarct and bilateral PICA infarctions. The patient was right hemiparetic.