Surgical treatment for ruptured anterior inferior cerebellar artery aneurysms

Abstract

Background Anterior inferior cerebellar artery (AICA) aneurysm is an extremely rare tumor, which can cause severe results after ruptured. This article retrospectively analyzed the clinical symptoms, imaging manifestations, surgical approaches, endovascular therapy and postoperative outcomes of 12 cases with AICA aneurysms, so as to provide reference for clinical practice. Methods Clinical data of patients with AICA aneurysms, who were treated in our hospital between June 2004 and June 2012, were carefully collected and studied. Glasgow Outcome Scale (GOS) scores were used to evaluate the patients' living status. Results There were 12 patients (the average age was 54 years old) with 13 ruptured aneurysms, accounting for 0.19% of all aneurysms (6467 cases) treated in the same period. CT showed simple subarachnoid hemorrhage (SAH) in 6 patients, simple ventricular hemorrhage in 1 patient and SAH complicated with ventricular hemorrhage in 5 patients. According to Hunt-Hess Grade, 2 patients were classified as Grade Ⅰ; 7 were Grade Ⅱ; 3 were Grade Ⅲ. Digital subtraction angiography (DSA) showed there were 10 saccular aneurysms and 3 fusiform aneurysms. Three aneurysms were located in the proximal segment of AICA (the junction of AICA and basilar artery), 3 premeatal segment (first bifurcation of AICA), 3 meatal and 4 postmeatal. The mean diameter was 3.90 mm. Three patients with 4 aneurysms were treated with microsurgery, of which clipping was carried out in 2 patients with 3 aneurysms and trapping in 1 case. Other 9 patients were treated with endovascular therapy, of which 2 cases underwent coil embolization, 3 stent-assisted coil, and 4 parent artery occlusion (PAO). Postoperative complications included facial paralysis (1 case), dysphagia and coughing when drinking (1 case) and contralateral hemianopia in both eyes (1 case). Follow-up was available in all of these cases for a mean of 36.41 months, with GOS scores 3 in 1 case, 4 in 2 cases and 5 in 9 cases. All the patients recovered well. Conclusion
AICA aneurysms are rare. The treatment includes microsurgery and endovascular therapy. For proximal, premeatal and meatal aneurysms, the retrosigmoidal approach is recommended; for the distal ones, the suboccipital approach with a center incision reverse to the ipsilateral (inverted 7 shaped) would be better for its minimal disturbance to cranial nerves. The endovascular therapy is recommended for all. For premeatal aneurysms, coiling or stent-assisted coiling would be good, even the aneurysms with wide neck are treated well; for distal ones, PAO is effective but the decision should be made very carefully for its potential risk of neurological deficits.