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AJNR - American Journal of Neuroradiology

Published ahead of print on July 17, 2008
doi: 10.3174/ajnr.A1218

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Endovascular Treatment of Peripheral Aneurysms of the Posterior Inferior Cerebellar Artery

J.-M. Isokangas^a, T. Siniluoto^a, T. Tikkakoski^c and T. Kumpulainen^b

^a Department of Radiology, Oulu University Hospital, Oulu, Finland
^b Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
^c Department of Radiology, Kokkola Central Hospital, Kokkola, Finland

View larger version (106K): [in this window] [in a new window]   Fig 1. A 46-year old woman (patient 4; Table) experienced acute onset of headache. MR imaging and MR angiography showed a right-sided PICA aneurysm without any evidence of intracranial bleeding. In initial DSA (A), a 9- x 5.5-mm sidewall aneurysm was visualized in a tonsillomedullary segment of the right PICA. The artery is narrowed proximally and dilated distally to the aneurysm neck. A balloon occlusion test was performed with indeterminate findings. The aneurysm was treated by endosaccular coiling with parent artery preservation. The initial occlusion grade was incomplete, but after retreatment a complete occlusion was achieved, and it has remained stable during follow-up (Fig 2B).

View larger version (66K): [in this window] [in a new window]   Fig 2. An 80-year-old woman (patient 10; Table) experienced severe vertigo with sudden onset. CT examination revealed a small right-sided intracerebral hematoma in cerebellar vermis, hemorrhage in the fourth ventricle, and prepontine cistern. Subsequent DSA revealed a dissecting aneurysm of the right PICA and a saccular aneurysm of the basilar tip (A). A superselective right PICA injection demonstrated an irregular, fusiform PICA aneurysm located in the cortical segment (B). Parent artery occlusion of the dissected cortical segment of PICA and coil embolization of the basilar tip aneurysm were performed in the same session. In control angiogram after the treatment, both aneurysms are occluded (C). Posttreatment CT showed PICA infarct, and the patient had temporary worsening of vertigo, but in 6 months of follow-up she recovered without any symptoms.