Article Figures & Data
Figures
- 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- × 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).
- 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.
Tables
Patient and aneurysm characteristics
Patient No./ Age, y/Sex HH Grade CT and MR Imaging Findings Aneurysm Site Aneurysm Etiology Aneurysm Progression Rebleeding before Treatment 1/46/F 1 SAH + IVH hydrocephalus Left telovelotonsillar Unknown No No 2/34/F 2 SAH + IVH Left telovelotonsillar Dissecting Yes No 3/52/F 1 SAH + IVH hydrocephalus Right lateromedullary Dissecting Yes Yes 4/46/F 0 Aneurysm (MRA) Right tonsillomedullary Unknown No Unruptured 5/60/M 1 SAH + IVH hydrocephalus Left cortical Dissecting Yes No 6/45/M 4 SAH + IVH + ICH + SDH hydrocephalus Left cortical Dissecting Yes No 7/52/M 4 SAH + IVH + ICH hydrocephalus Right cortical Dissecting Yes 8/53/M 5 SAH + IVH + ICH hydrocephalus Right tonsillomedullary Dissecting Yes Yes 9/64/F 2 SAH + IVH hydrocephalus Right tonsillomedullary Unknown No No 10/80/F 1 SAH + IVH + ICH Right cortical Dissecting No 11/40/M 0 Incidental finding (DSA) Left tonsillomedullary Unknown No Unruptured 12/70/F 1 IVH hydrocephalus Right telovelotonsillar Unknown No Note:—HH indicates Hunt and Hess classification; F, female; M, male; SAH, subarachnoid hemorrhage; IVH, intraventricular hemorrhage; MRA, MR angiography; ICH, intracerebral hemorrhage; SDH, subdural hemorrhage; DSA, digital subtraction angiography.
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