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J Neurol Surg A Cent Eur Neurosurg 2012; 73(05): 267-274
DOI: 10.1055/s-0032-1304213
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Strategies in the Treatment of Distal Cerebellar Aneurysms: Report of a Series of 11 Patients

Ali Harati
1   Department of Neurosurgery, Klinikum Vest, Recklinghausen, Germany
,
Anastasios Mpotsaris
2   Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany
,
Frauke Lohmann
1   Department of Neurosurgery, Klinikum Vest, Recklinghausen, Germany
,
Christian Loehr
2   Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany
,
Werner Weber
2   Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany
,
Maximilian J. A. Puchner
1   Department of Neurosurgery, Klinikum Vest, Recklinghausen, Germany
› Institutsangaben
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Publikationsverlauf

25. März 2011

19. Oktober 2011

Publikationsdatum:
14. Mai 2012 (online)

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Abstract

Background Distal cerebellar artery aneurysms are rare entities and treatment modalities technically challenging. In recent years, new therapeutic options have emerged through microsurgical and endovascular means.

Objective Based on a series of 11 cases, we describe combined interdisciplinary treatment strategies and report the outcome in a midterm follow-up interval of 12 months.

Methods Collection of clinical case data during acute phase and follow-up including standardized angiographic control intervals during follow-up and assessment of the outcome.

Results 7 of 11 reported cases had flow-related aneurysms based on an underlying arteriovenous malformation (AVM) or dural arteriovenous fistula (DAVF); we found multiple aneurysms in four cases. All patients with flow-related aneurysms presented with subarachnoid hemorrhage (SAH). Only one of four patients in this series without an underlying AVM or DAVF presented with SAH that was attributable to a distal cerebellar aneurysm. In one case, we observed a de novo formation of two flow-associated distal aneurysms (10 years interval). Two patients were treated conservatively, five patients were treated endovascularly, one patient was treated surgically and three patients were treated with combined methods. 9 of 11 patients with initial SAH had a good outcome.

Conclusions Distal cerebellar aneurysms associated with AVM or DAVF are rare but characterized by a high risk of hemorrhage. The present series indicates that an experienced interdisciplinary team and the combination of available techniques may lead to a reduction of complications and to a better outcome.

Keywords

intracranial aneurysm - arteriovenous malformation - posterior fossa - SAH
 

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