Right occipital to Right distal PICA bypass and trapping of ruptured Right PICA dissecting aneurysm after initial coil embolization

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-24 DOI:10.1016/j.jocn.2025.111342

Sameer S. Tebha , Rahim Abo Kasem, Samaher Fageiry, Brent G. Oxford, Kim Meyer, Akshitkumar Mistry , Dale Ding , Isaac Josh Abecassis

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引用次数: 0

Abstract

Posterior inferior cerebellar artery (PICA) aneurysms are rare, constituting less than 5 % of intracranial aneurysms, and are associated with a high rupture risk [1]. Management is challenging due to proximity to brainstem structures, the need for vessel reconstruction or excision, and the risk of ischemia in PICA territory [2,3]. We present a case of subarachnoid hemorrhage caused by a ruptured, dissecting ∼1 cm proximal PICA aneurysm. The aneurysm had a calcified neck, and the contralateral PICA was small and not adjacent to the ipsilateral PICA. Treatment was staged: first, partial endovascular coil embolization to prevent re-rupture during ICU care [4,5], followed by an occipital-to-PICA artery (p3) bypass via a far lateral approach. The bypass enabled successful aneurysm trapping and resection. This case demonstrates the importance of staged endovascular and surgical interventions in managing large, complex aneurysms and highlights technical aspects of posterior circulation bypass.

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右枕部至右远端异室间隔搭桥及初始线圈栓塞后捕获破裂的右异室间隔夹层动脉瘤

小脑后下动脉（PICA）动脉瘤是罕见的，占颅内动脉瘤的不到5%，并与高破裂风险[1]相关。由于靠近脑干结构，需要血管重建或切除，以及PICA区域缺血的风险，治疗具有挑战性[2,3]。我们报告一个蛛网膜下腔出血的病例，由破裂，解剖近端1厘米的异位动脉瘤引起。动脉瘤颈钙化，对侧异食癖很小，不与同侧异食癖相邻。治疗分阶段进行：首先，在ICU护理期间进行部分血管内线圈栓塞以防止再次破裂[4,5]，然后通过远侧入路进行枕动脉-异位动脉（p3）旁路手术。旁路手术成功捕获并切除了动脉瘤。本病例证明了分阶段血管内和手术介入治疗大型复杂动脉瘤的重要性，并强调了后循环搭桥的技术方面。

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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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.