Superior Cerebellar Artery Aneurysms Causing Facial Pain: A Comprehensive Review

2019 ◽  
Vol 18 (1) ◽  
pp. 2-11
Author(s):  
Javier Ros de San Pedro
Keyword(s):  
Treatment Options ◽  
Rare Event ◽  
Outcome Data ◽  
Superior Cerebellar Artery ◽  
Illustrative Case ◽  
Clinical Onset ◽  
Female Predominance ◽  
Cerebellar Artery ◽  
Lateral Posterior ◽  
Mean Size

Abstract BACKGROUND Trigeminal neuralgia caused by superior cerebellar artery aneurysms (TGN-SCAAs) is a rare event without previous analysis. OBJECTIVE To describe the features of TGN-SCAA based on 8 cases (7 from literature +1 illustrative case). METHODS All cases were thoroughly studied with gathering of their epidemiological, radiological, clinical, therapeutic, and outcome data. RESULTS The mean age at diagnosis was 61 yr. Gender distribution showed a female predominance (M: F = 2:6). Side distribution had a left dominance (75%). The aneurysms mean size was 15.4 mm (range: 5-27). All 5 proximal SCAAs (SCA-Basilar junction) presented a lateral-posterior projection, while all 3 distal SCAAs (s2 segment) had variable projections but constant direct trigeminal nerve (TN) contact. No hemorrhage occurred. TGN was the clinical onset in all 8 cases. The most frequent pain distribution was V1-2-3 (n = 3), followed by V1-2 (n = 1) and V1 alone (n = 1). Proximal SCAAs caused TGN through direct TN compression (n = 1), third nerve compression (n = 1), cavernous sinus compression (n = 1), or a combination thereof (n = 2). However, all distal SCAAs caused TGN by direct TN compression (n = 3). Two different treatment options were used: clipping (n = 4) and coiling (n = 4). The post-treatment Barrow Neurological Institute score for pain control was I in all cases (100%). The mRS score was 0 in 75% of cases. CONCLUSION TGN-SCAAs are infrequent lesions, characterized by large size, variable TGN mechanisms depending on their anatomic location, and mostly affecting the first and second trigeminal divisions. Both SCAA clipping and coiling were used equally, providing good neurological and pain relief results.

scholarly journals Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

2017 ◽  
Vol 14 (2) ◽  
pp. 3-7
Author(s):  
Gopal R Sharma ◽  
Rajiv Jha ◽  
Prakash Poudel ◽  
Dhrub R Adhikari ◽  
Prakash Bista
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Treatment Options ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Recurrent Pain ◽  
Cerebellar Artery

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:11-15

scholarly journals Flow diversion and microvascular plug occlusion for the treatment of a complex unruptured basilar/superior cerebellar artery aneurysm: case report

2019 ◽  
Vol 130 (6) ◽  
pp. 1978-1983 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Howard A. Riina ◽  
Omar Tanweer ◽  
Peyman Shirani ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Endovascular Approach ◽  
Aneurysm Occlusion ◽  
The Right

The authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. A 2-staged (combined deconstructive/reconstructive) procedure was successfully performed: first occluding the left SCA with a Pipeline embolization device (PED) coupled to a microvascular plug (MVP) in the absence of antiplatelet coverage, followed by reconstruction of the BAT by deploying a second PED from the right SCA into the basilar trunk. Six-month follow-up angiography confirmed uneventful aneurysm occlusion. The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.

scholarly journals Superficial temporal artery–superior cerebellar artery bypass and trapping of a fusiform aneurysm using intradural anterior petrosectomy: technical case report and anatomical study

2019 ◽  
Vol 46 (2) ◽  
pp. E9
Author(s):  
Soichi Oya ◽  
Masahiro Indo ◽  
Masabumi Nagashima ◽  
Toru Matsui
Keyword(s):  
Artery Bypass ◽  
Treatment Options ◽  
Superficial Temporal Artery ◽  
Anatomical Study ◽  
Temporal Artery ◽  
Distal Portion ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Cerebellar Artery ◽  
Anterior Petrosectomy

Aneurysms at the distal portion of the superior cerebellar artery (SCA) are very rare. Because of the deep location and a propensity for nonsaccular morphology, aneurysm trapping or endovascular occlusion of the parent artery are the usual treatment options, which are associated with varying risks of ischemic complications. The authors report on a 60-year-old woman who had a 3.5-mm unruptured aneurysm in the lateral pontomesencephalic segment of the SCA with a significant interval growth to 8 mm. Direct surgical intervention comprising trapping of the aneurysm through a subtemporal approach and intradural anterior petrosectomy combined with revascularization of the distal SCA using the superficial temporal artery (STA) was performed. This approach provided sufficient space for the bypass instruments to be introduced into the deep surgical field at a more favorable angle to enhance microscopic visualization of the anastomosis with minimal retraction of the temporal lobe. The patient was discharged with no neurological deficit. Preservation of the blood flow in the distal SCA should be attempted to minimize the risk of ischemic injury, particularly when the aneurysms arise in the anterior or lateral segment of the SCA. The authors demonstrate the safety and effectiveness of the intradural anterior petrosectomy for STA-SCA bypass along with a relevant anatomical study.

scholarly journals Treatment of intracranial vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery origin

2019 ◽  
Vol 10 ◽  
pp. 116 ◽  
Author(s):  
Jason A. Chen ◽  
Matthew C. Garrett ◽  
Anton Mlikotic ◽  
James I. Ausman
Keyword(s):  
Vertebral Artery ◽  
Complex Disease ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Treatment Strategies ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Illustrative Case ◽  
Parent Vessel ◽  
Cerebellar Artery

Background: Vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) is a complex disease entity in which the dual goals of preventing future rebleeding and maintaining perfusion of the lateral medulla must be considered. We present an illustrative case and review the literature surrounding treatment strategies. Case Description: We report a patient presenting with extensive subarachnoid hemorrhage due to rupture of an intracranial VADA involving the PICA origin. After consideration of the patient’s cerebral vasculature and robustness of collaterals, a flow-diverting stent was placed with angiographic resolution of the lesion and maintenance of antegrade PICA flow. Ultimately, the patient experienced a contralateral intraparenchymal hemorrhage leading to death. Review of the literature identified 124 cases of VADA involving the PICA origin described over the past decade. The methods of surgical and endovascular treatment of these cases were reviewed, with particular focus on the rationale of treatment, outcomes, and complications. Conclusion: Numerous treatment options for VADA involving PICA have been reported with different risk and benefit profiles. Flow-diverting stents appear to offer the most favorable balance of securing the aneurysm and avoiding medullary infarction, but the risks and optimal anti-thrombotic treatment strategy are incompletely understood. In select cases, in which the surgical risk is low or in which the anatomy is favorable (e.g., nondominant parent vessel or robust collateral circulation in the involved territories), parent artery trapping with or without microsurgical revascularization can be considered.

Acute Treatment of Ruptured Fusiform Posterior Circulation Posterior Cerebral, Superior Cerebellar, and Posterior Inferior Cerebellar Artery Aneurysms With FRED Flow Diverter: Report of 5 Cases

2018 ◽  
Vol 16 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Dan Laukka ◽  
Riitta Rautio ◽  
Melissa Rahi ◽  
Jaakko Rinne
Keyword(s):  
Treatment Time ◽  
Brain Infarction ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
External Ventricular Drainage ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Technical Success Rate ◽  
Cerebellar Artery

Abstract BACKGROUND Flow diverter (FD) treatment of ruptured fusiform posterior cerebral artery (PCA), posterior inferior cerebellar artery (PICA), and superior cerebellar artery (SCA) aneurysms are limited to single reports. OBJECTIVE To study the safety and efficacy of FD treatment for ruptured fusiform aneurysms of the PCA, SCA, and PICA. METHODS Five patients with ruptured posterior circulation fusiform aneurysms and treated with a Flow-Redirection Endoluminal Device (FRED/FRED Jr; Microvention, Tustin, California) stent in the acute phase of subarachnoid hemorrhage between 2013 and 2016 were included and reviewed retrospectively. RESULTS Two aneurysms located on the PICA, 2 on PCA, and 1 on the SCA. Mean treatment time with FD was 5.8 d (range, 0-11 d) from ictus. The technical success rate was 100%. On admission 2 patients were Hunt and Hess grade 1, 2 patients grade 3, and 1 patient grade 4. At discharge, 4 patients (80%) were independent (modified Ranking Scale (mRS) ≤2) and 1 patient had severe disability (mRS 4). None of the patients had aneurysmal rebleeding. All 5 aneurysms were completely occluded on angiographic follow-up (range, 3-22 mo). One patient had permanent intraprocedural in stent thrombosis and brain infarction. One patient had spontaneous nonaneurysmal intracerebral hemorrhage 1 mo after FD treatment. External ventricular drainage was inserted in 3 patients and ventriculoperitoneal shunt in 2 patients without hemorrhagic complications despite dual antiplatelet therapy. CONCLUSION FD could be considered as a treatment option for ruptured fusiform aneurysms located on PCA, PICA, or SCA when other treatment options are challenging.

scholarly journals Traumatic aneurysm at the superior cerebellar artery: illustrative case

2021 ◽  
Vol 2 (24) ◽  
Keyword(s):  
Head Injury ◽  
Clinical Presentation ◽  
Superior Cerebellar Artery ◽  
Subdural Hemorrhage ◽  
Illustrative Case ◽  
Traumatic Aneurysm ◽  
Intracranial Hemorrhages ◽  
Cerebellar Artery ◽  
Traumatic Aneurysms ◽  
In The Beginning

BACKGROUND Traumatic aneurysms at the superior cerebellar arteries after head injury are extremely rare and may be overlooked. Rupture of these aneurysms can cause fatal intracranial hemorrhages; thus, early identification of the entity helps prevent detrimental outcomes. OBSERVATIONS A patient suffered from sudden severe headache and decreased consciousness level several weeks after a blunt head injury. He received surgery to remove a progressive enlarging subdural hematoma. The diagnosis of a traumatic aneurysm at the superior cerebellar artery was delayed, made only after a recurrent subdural hemorrhage occurred. He received another surgery to obliterate the aneurysm. LESSONS The patient could have been treated earlier if traumatic aneurysm had been suspected in the beginning. In addition to the case, the authors also reviewed the literature to clarify the pathophysiology, clinical presentation, diagnosis, and management of the disease.

Efficacy of carbamazepine on cerebellar tremors in patients with superior cerebellar artery syndrome

1989 ◽  
Vol 236 (8) ◽  
pp. 461-463 ◽  
Author(s):  
G. P. Sechi ◽  
A. Pirisi ◽  
V. Agnetti ◽  
M. Piredda ◽  
M. Zuddas ◽  
...  
Keyword(s):  
Superior Cerebellar Artery ◽  
Cerebellar Artery

scholarly journals Thrombectomy in posterior circulation stroke through persistent primitive trigeminal artery: A case report

2015 ◽  
Vol 21 (6) ◽  
pp. 715-718 ◽  
Author(s):  
MJHL Mulder ◽  
GJ Lycklama à Nijeholt ◽  
W Dinkelaar ◽  
TPW de Rooij ◽  
ACGM van Es ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Trigeminal Artery ◽  
Left Hand ◽  
Persistent Primitive Trigeminal Artery ◽  
Cerebellar Artery ◽  
Intervention Patient ◽  
Primitive Trigeminal Artery ◽  
The Right ◽  
Neurovascular Anatomy

We describe a case of intra-arterial treatment (IAT) of acute posterior circulation occlusion in a patient with a persistent primitive trigeminal artery (PPTA). The patient presented with an acute left sided hemiparesis and loss of consciousness (Glasgow coma score of 5). Computed tomography angiography showed an acute occlusion of the right internal carotid artery (ICA), the PPTA, distal basilar artery (BA), right posterior cerebral artery (PCA), and right superior cerebellar artery (SCA). Stent-retriever assisted thrombectomy was not considered possible through the hypoplastic proximal BA. After passage of the proximal ICA occlusion, the right PCA and SCA were recanalized through the PPTA, with a single thrombectomy procedure. Ten days after intervention patient was discharged scoring optimal EMV with only a mild facial and left hand paresis remaining. PPTA is a persistent embryological carotid–basilar connection. Knowledge of existing (embryonic) variants in neurovascular anatomy is essential when planning and performing acute neurointerventional procedures.

Intracranial Vertebral Endarterectomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 465-471 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Balaji Sadasivan ◽  
Manuel Dujovny
Keyword(s):  
Vertebral Artery ◽  
Medical Therapy ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Focal Lesion ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

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