[A ruptured peripheral, superior cerebellar artery aneurysm: a case report and a review of the literature as to surgical approaches].

The authors described the case of a normotensive 40-year-old female with severe headache and vomiting. Neurological findings on admission to our hospital revealed no deficits, but plain CT findings indicated subarachnoid hemorrhage in the ambient, supracerebellar, quadrigeminal, and right lateral pontine cisterns. Left vertebral angiograms made through a transfemoral catheter revealed a saccular aneurysm (6 x 4mm) arising from the medical hemispheric branch of the right superior cerebellar artery (SCA). On the 34th day after onset of her symptoms, the aneurysm was successfully clipped by using an infratentorial supracerebellar approach. She was discharged with no deficits. Based on our experience and a review of the literature, a peripheral SCA aneurysm is best clipped by using one of the following surgical approaches: (1) a subtemporal transtentorial approach for an aneurysm arising from the anterior or lateral pontomesencephalic segment, (2) a subtemporal or occipital transtentorial approach for an aneurysm arising from the cerebellomesencephalic segment or the proximal cortical branch, or (3) an infratentorial supracerebellar approach for an aneurysm arising from the distal cortical branch.