J Korean Neurosurg Soc.  2012 Jan;51(1):40-43. 10.3340/jkns.2012.51.1.40.

Dissecting Aneurysm Associated with a Double Origin of the Posterior Inferior Cerebellar Artery Causing Subarachnoid Hemorrhage

• Koh JS
• Lee CY
• Lee SH
• Kim GK

• KMID: 2190468
• DOI: http://doi.org/10.3340/jkns.2012.51.1.40

Abstract

Two cases of the posterior fossa dissecting aneurysm associated with a double origin of the posterior inferior cerebellar artery (DOPICA) causing subarachnoid hemorrhage are presented. After observing a relationship between the aneurysm and DOPICA on a three dimensional rotational angiogram (3DRA), the dissecting aneurysms were successfully obliterated by surgical trapping and endovascular internal trapping, respectively. This report warrants suspecting DOPICA of an associating anomaly predisposing to dissecting aneurysm in the vertebral artery-posterior inferior cerebellar artery territory and highlights the role of 3DRA in pretreatment evaluation of unusual aneurysms accompanying a particular anatomical variation.

Keyword

Anomaly; Dissecting aneurysm; Posterior inferior cerebellar artery; Three dimensional rotational angiogram

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Arteries
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Case 1. Anteroposterior (AP) view of left vertebral artery (VA) angiogram (A) showing a peripheral aneurysm (arrow head) located on the hemispheric branch of the posterior inferior cerebellar artery (PICA) which has a low origin on the V4 (double arrowhead). Lateral view of left VA angiogram (B) demonstrating that a small cranial branch (arrow) originating from the distal V4 is directly anastomosed with the PICA. AP view of right VA angiogram (C) showing contrast filling of the aneurysm (arrowhead) through a small branch (arrow) originating on the distal V4. Reconstructed 3-dimensional rotational angiogram (D) clearly demonstrating the upper (arrows) and lower (double arrowheads) channel of double origin of the PICA and an associating aneurysm (arrowhead). Intraoperative photograph (E) showing trapping of the distal PICA (double arrowheads) harboring aneurysm (arrowhead). Follow-up right VA angiogram obtained 3 weeks after surgical trapping (F) showing a patent flow in the hemispheric branch of the left PICA (broken arrows) by collaterals and complete exclusion of the dissecting aneurysm.

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  Fig. 2 Case 2. Right vertebral artery (VA) angiogram (A and B) obtained at admission showing an irregular constriction and outpouching of the right VA and revealing an extracranial origin PICA. Follow-up right VA angiogram obtained 3 days after admission (C) showing growing of aneurismal dilations from which a faint vessel arises (arrows). Enlarged, oblique view, 3DRA of the right VA (D) demonstrating that a small upper branch (arrowhead) originating from the proximal aneurysm (arrow) is directly anastomosed with the PICA (open arrowhead). The anterior spinal artery (broken arrow) originating on the V4 is located just distal to the dissection. Postoperative, lateral view of right VA angiogram (E) and AP view of left VA angiogram (F) showing total occlusion of the right VA in which are detachable coils (asterisk). PICA : posterior inferior cerebellar artery, 3DRA : three dimensional rotational angiogram, AP : anteroposterior.

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