Sapporo Asabu Neurosurgical Hospital, Higashi-ku, Sapporo 007-0840, Japan.
Acta Neurochir (Wien). 2010 Mar;152(3):515-8. doi: 10.1007/s00701-009-0446-7. Epub 2009 Jul 9.
Aneurysms of the choroidal branches of the posterior inferior cerebellar artery (PICA) are quite rare; only seven such cases have been reported thus far. In this study, we present a very rare case of a ruptured aneurysm of a choroidal branch of the PICA; the aneurysm was exposed by splitting the vermis and resected after proximal arterial ligation. We have also undertaken a thorough review of the literature on aneurysms in choroidal branches of the PICA, focusing on the clinical presentation, etiology, radiological findings, and surgical strategies. We found that the aneurysms in our patient and the aneurysms in seven published case reports were small, and frequently associated with vascular anomalies. Intraventricular hemorrhage (IVH) in the fourth ventricle was detected in all eight cases. The outcomes of surgical treatment were generally favorable, notwithstanding the high incidence of rebleeding after rupture of distal PICA aneurysms. The recognition of predominant fourth ventricular hemorrhage should raise the suspicion of the presence of an underlying aneurysm, and digital subtraction angiograms (DSAs) should be immediately obtained in order to detect small aneurysms of the choroidal branches of the PICA.
小脑后下动脉（PICA）脉络膜支动脉瘤非常罕见；迄今为止，仅报道了 7 例此类病例。在本研究中，我们报告了一例非常罕见的 PICA 脉络膜支破裂性动脉瘤；通过劈开蚓部暴露动脉瘤，并在近端动脉结扎后切除。我们还对 PICA 脉络膜支动脉瘤的文献进行了全面回顾，重点关注临床表现、病因、影像学发现和手术策略。我们发现，我们的患者的动脉瘤和 7 篇已发表病例报告中的动脉瘤较小，并且经常与血管异常有关。在所有 8 例患者中均发现第四脑室的脑室出血（IVH）。尽管 PICA 远端动脉瘤破裂后再出血的发生率很高，但手术治疗的结果通常是有利的。第四脑室出血的明显表现应引起对潜在动脉瘤的怀疑，并应立即获得数字减影血管造影（DSA）以检测 PICA 脉络膜支的小动脉瘤。
