Nonaka Senshu, Oishi Hidenori, Tsutsumi Satoshi, Ishii Hisato
Department of Neurosurgery, Juntendo University Urayasu Hospital, Urayasu, Chiba 279-0021, Japan.
Department of Neurosurgery, Juntendo University School of Medicine, Urayasu, Chiba 279-0021, Japan.
Asian J Neurosurg. 2018 Oct-Dec;13(4):1250-1251. doi: 10.4103/ajns.AJNS_180_17.
Cerebral aneurysms arising on the peripheral posterior inferior cerebellar artery (PICA) are rare. Here, we present a unique case of arteriovenous malformation (AVM) with pedicle aneurysms arising on the peripheral PICA and recruited by meningeal supply. A 67-year-old woman presented with subarachnoid hemorrhage. Cerebral angiography revealed two saccular aneurysms on the peripheral PICA, which formed an abnormal arteriovenous shunt adjacent to the transverse sinus. The shunt was also fed by the ipsilateral superior cerebellar and contralateral posterior meningeal arteries. The proximal aneurysm was larger and deep seated while the distal aneurysm was smaller and located superficially. The patient underwent coil embolization of the proximal aneurysm followed by microsurgical trap of the distal aneurysm and resection of the arteriovenous shunt lying superficially in the cerebellar hemisphere. The shunt was histologically verified as AVM. Staged approach with coil embolization and open microsurgery can be a treatment option for multiple PICA aneurysms associated with an AVM.
起源于外周小脑后下动脉（PICA）的脑动脉瘤很罕见。在此，我们报告一例独特的动静脉畸形（AVM）病例，其蒂状动脉瘤起源于外周PICA并由脑膜供血。一名67岁女性因蛛网膜下腔出血就诊。脑血管造影显示外周PICA上有两个囊状动脉瘤，在横窦附近形成异常动静脉分流。该分流也由同侧小脑上动脉和对侧脑膜后动脉供血。近端动脉瘤较大且位置深，而远端动脉瘤较小且位于浅表。患者先接受了近端动脉瘤的弹簧圈栓塞，随后对远端动脉瘤进行显微手术夹闭，并切除位于小脑半球浅表的动静脉分流。经组织学证实该分流为AVM。弹簧圈栓塞和开放式显微手术的分期治疗方法可作为与AVM相关的多发PICA动脉瘤的一种治疗选择。
