Microsurgical Management of Anterior Inferior Cerebellar Artery Aneurysms: Case Series and Review of Advanced Imaging and Cranial Base Approaches.
Abstract
[BACKGROUND] Anterior Inferior Cerebellar Artery (AICA) aneurysms are rare, accounting for 0.1% to 0.5% of posterior circulation aneurysms. They often present with diverse morphologies and clinical symptoms, challenging diagnosis and management.
[CASE DESCRIPTIONS] We report three cases of AICA aneurysms with distinct clinical presentations and management strategies. Case 1: A 56-year-old male presented with chronic headache and left hemiparesis. MRI and 3D TOF MRA revealed a fusiform AICA aneurysm compressing the pons, treated with microsurgical clipping via anterior petrosectomy, resulting in a favorable outcome (mRS score of 0). Case 2: A 26-year-old female with a sudden-onset sentinel headache had a wide-neck saccular aneurysm of the right AICA confirmed by DSA. A posterior petrosectomy approach with clipping was performed, achieving complete aneurysm exclusion without complications (mRS score of 0). Case 3: A 21-year-old male with an incidentally detected saccular aneurysm underwent DSA and 3D angio-CT, confirming a wide-neck saccular aneurysm in the AICA territory. Microsurgical clipping via anterior petrosectomy was successful, with no residual lesion (mRS score of 0).
[CONCLUSION] Microsurgical clipping remains a viable option for managing wide-neck and fusiform AICA aneurysms, particularly those unsuitable for endovascular techniques. Advanced imaging modalities and tailored cranial base approaches are crucial for optimizing outcomes. Further studies are needed to refine management strategies for these rare aneurysms.
[CASE DESCRIPTIONS] We report three cases of AICA aneurysms with distinct clinical presentations and management strategies. Case 1: A 56-year-old male presented with chronic headache and left hemiparesis. MRI and 3D TOF MRA revealed a fusiform AICA aneurysm compressing the pons, treated with microsurgical clipping via anterior petrosectomy, resulting in a favorable outcome (mRS score of 0). Case 2: A 26-year-old female with a sudden-onset sentinel headache had a wide-neck saccular aneurysm of the right AICA confirmed by DSA. A posterior petrosectomy approach with clipping was performed, achieving complete aneurysm exclusion without complications (mRS score of 0). Case 3: A 21-year-old male with an incidentally detected saccular aneurysm underwent DSA and 3D angio-CT, confirming a wide-neck saccular aneurysm in the AICA territory. Microsurgical clipping via anterior petrosectomy was successful, with no residual lesion (mRS score of 0).
[CONCLUSION] Microsurgical clipping remains a viable option for managing wide-neck and fusiform AICA aneurysms, particularly those unsuitable for endovascular techniques. Advanced imaging modalities and tailored cranial base approaches are crucial for optimizing outcomes. Further studies are needed to refine management strategies for these rare aneurysms.