Document Detail

Diagnosis and surgical management of extracranial PICA aneurysms presenting through subarachnoid haemorrhage: Case report and review of the literature.
MedLine Citation:
PMID:  19651470     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE AND IMPORTANCE: We present a very unusual case in which a proximal posterior inferior cerebellar artery (PICA) aneurysm was located extracranially. We reviewed the PICA origin anatomy and pathology of aneurysms at this site. CLINICAL PRESENTATION: A Caucasian woman, 52 years of age, presented with a lesion at the craniocervical junction. She complained only of headache off and on without other symptoms. Her physical examination was unremarkable. A CT angiography clearly visualized an approximately 9-mm wide aneurysm of the right PICA which lay intradurally in the spinal canal at the C(1)-level. Surgery was planned. However, six weeks after her initial referral and just before her surgical date, the patient suffered a subarachnoid haemorrhage. Physical examination at that time showed a lethargic but conscious patient, with slight disorientation (Glasgow Coma Score 14; Hunt and Hess grade III). INTERVENTION: The aneurysm was successfully treated by microneurosurgical techniques via a suboccipital craniotomy with laminectomy of C(1) as well. Temporary clipping of the PICA was feasible and the aneurysm could be dissected and clipped appropriately. CONCLUSION: The present report underscores the anatomical variants of the PICA. Although uncommon, PICA aneurysms do occur and caretakers should be aware of this when treating patients with clinical signs or CT evidence of subarachnoid haemorrhage. Even extracranial PICA aneurysms can be encountered, either through a caudal loop or an early extracranial lateral medullary segment. We stress the use of four vessel angiography or CT angiography with thin cuts to rule out such aneurysms.
Ruben Dammers; Ali F Krisht; Sharon Partington
Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-08-03
Journal Detail:
Title:  Clinical neurology and neurosurgery     Volume:  111     ISSN:  1872-6968     ISO Abbreviation:  Clin Neurol Neurosurg     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-05     Completed Date:  2009-12-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7502039     Medline TA:  Clin Neurol Neurosurg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  758-61     Citation Subset:  IM    
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Cerebral Revascularization*
Cerebrovascular Circulation / physiology
Glasgow Coma Scale
Image Processing, Computer-Assisted
Intracranial Aneurysm / diagnosis,  surgery*
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Middle Aged
Subarachnoid Hemorrhage / diagnosis,  surgery*
Tomography, X-Ray Computed

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