PICA flow-related aneurysms and posterior fossa AVM: rare association and challenging management: case presentation and review of literature

IF 0.7 Q4 CLINICAL NEUROLOGY
Dognon Kossi François de Paule Adjiou, Salma Abbas, Oumaima Benali, Baba Alhaji Bin Alhassan, Othmane El Manouni, Meryem Kajeou, Abdessamad El Ouahabi
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Abstract

The association of an infratentorial arteriovenous malformations (AVMs) with a PICA aneurysm is very rare and the presence of associated aneurysms was an independent predictive factor of poor outcome at follow-up for posterior fossa AVMs (pfAVMs). We report the case of a 57-year-old female patient admitted to our institution with a challenging management of a pfAVM associated with multiple flow-related aneurysms of the PICA. A 57-year-old patient with no medical past history was admitted to our emergency department with a sudden onset headache and severe neck stiffness. A cerebral CT Scan showed a cerebellar hematoma. Digital subtraction angiography demonstrates a right paramedian supero-posterior infratentorial AVM located at the posterosuperior part of the right cerebellar hemisphere with a small compact nidus supplied by branches of the right PICA and the right superior cerebellar artery. Venous drainage being toward the torcular. The AVM is associated with 3 flow-related aneurysms. We opted for surgical treatment of the 2 high-flow aneurysms on the distal branch of the right PICA. Patient was then sent for radiosurgery for the AVM. We opted for observation of the left small aneurysm. Microsurgery for PICA aneurysms is particularly well suited because exposure through a far-lateral craniotomy is excellent. Endovascular embolization can be used to occlude the aneurysm as well as treat the AVM at the same time in certain circumstances. Clipping or coiling the aneurysm should be discussed in a multidisciplinary meeting.
PICA 血流相关动脉瘤和后窝动静脉畸形:罕见的关联和具有挑战性的管理:病例介绍和文献综述
脑室下动静脉畸形(AVM)与 PICA 动脉瘤伴发的情况非常罕见,伴发动脉瘤是后窝动静脉畸形(pfAVM)随访结果不佳的独立预测因素。我们报告了本院收治的一例 57 岁女性患者的病例,她的后窝动静脉畸形伴有 PICA 多发性血流相关动脉瘤,治疗难度很大。一名 57 岁的患者无病史,因突发头痛和严重颈部僵硬被送入我院急诊科。脑部 CT 扫描显示小脑血肿。数字减影血管造影显示,位于右侧小脑半球后上部的右侧旁超后方脑室下动静脉畸形,有一个由右侧 PICA 和右侧小脑上动脉分支供应的小而密的瘤巢。静脉引流向小脑环。动静脉畸形伴有 3 个血流相关动脉瘤。我们选择手术治疗右侧 PICA 远端分支上的 2 个高流量动脉瘤。然后,患者被送去接受放射外科手术治疗 AVM。我们选择对左侧小动脉瘤进行观察。显微手术治疗 PICA 动脉瘤尤其合适,因为通过远外侧开颅手术可以很好地暴露动脉瘤。在某些情况下,血管内栓塞术可用于闭塞动脉瘤并同时治疗 AVM。动脉瘤的夹闭或卷曲应在多学科会议上讨论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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