Cerebral vascular reconstruction in the treatment of abnormal anastomosis of origin posterior inferior cerebellar artery complicated with aneurysms: two cases reports and literature review

Abstract

Objective Summarize the clinical characteristics and treatment plan of 2 cases of abnormal anastomosis at the origin of the posterior inferior cerebellar artery (PICA) complicated with aneurysm. Methods and Results Two cases of abnormal anastomosis of the PICA complicated with aneurysms all showed spontaneous subarachnoid hemorrhage (SAH). MRI showed abnormal anastomosis of the PICA, accompanied by multiple small aneurysms at the anastomotic vessel or anastomotic site. All patients underwent occipital artery (OA)⁃PICA bypass graft and electrocoagulation of the aneurysms at the same time. Use "PICA anastomosis" as the key words to search PubMed (January 1, 2000 to June 30, 2021) 8 articles in English, 8 patients, combined with 2 cases in this article cases, a total of 10 patients with abnormal anastomosis at the origin of the PICA complicated with aneurysm. All cases occurred as spontaneous SAH; 8 cases of aneurysms occurred at the anastomosis site, one case occurred at the distal end of the PICA, and one case occurred in a branch of the original artery. Five cases underwent craniotomy, 3 cases of OA⁃PICA bypass surgery and concurrent electrocoagulation (2 cases) or clipping (one case) of the aneurysms, one case of simple aneurysm clipping, and one case of aneurysm clipping combined with cutting off anastomotic artery, and there were no clear complications after surgery; 4 cases underwent endovascular interventional treatment, 2 cases of coil embolization of aneurysms, 2 cases of Glubran glue embolization of aneurysms, of which 3 cases had postoperative complications, manifested as mild brainstem infarction (2 cases) or disturbance of consciousness (one case). Conclusions Abnormal anastomosis at the origin of the PICA complicated with aneurysm is rare, and the risk of rupture and hemorrhage is high. OA⁃PICA bypass and electrocoagulation or clipping of the aneurysm can be used as a treatment option.

doi：10.3969/j.issn.1672⁃6731.2021.11.012