Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report
10.7461/jcen.2023.E2023.05.006
- Author:
Lívio Pereira DE MACÊDO
1
;
Delson Culembe BAPTISTA-ANDRÉ
;
Arlindo UGULINO-NETTO
;
Kauê FRANKE
;
Pierre Vansant OLIVEIRA EUGÊNIO
;
Auricélio Batista CEZAR-JUNIOR
;
Igor Vilela FAQUINI
;
Eduardo Vieira DE CARVALHO-JÚNIOR
;
Nivaldo S. ALMEIDA
;
Hildo Rocha Cirne AZEVEDO-FILHO
Author Information
1. Department of Neurosurgery, Hospital da Restauração, Recife, Brazil
- Publication Type:Case Report
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2024;26(2):216-222
- CountryRepublic of Korea
- Language:English
-
Abstract:
Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.
