Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report.
Lívio Pereira de MacêdoDelson Culembe Baptista-AndréArlindo Ugulino-NettoKauê FrankePierre Vansant Oliveira EugênioAuricélio Batista Cezar-JuniorIgor Vilela FaquiniEduardo Vieira de Carvalho-JúniorNivaldo S AlmeidaHildo Rocha Cirne Azevedo-FilhoPublished in: Journal of cerebrovascular and endovascular neurosurgery (2023)
Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.
Keyphrases
- computed tomography
- case report
- patients undergoing
- coronary artery
- systematic review
- subarachnoid hemorrhage
- magnetic resonance imaging
- positron emission tomography
- atrial fibrillation
- mental health
- contrast enhanced
- early onset
- magnetic resonance
- brain injury
- abdominal aortic aneurysm
- dual energy
- combination therapy
- metabolic syndrome
- internal carotid artery
- blood brain barrier
- cerebral ischemia
- skeletal muscle
- weight loss
- glycemic control