Association of a Distal Intradural-Extracranial Posterior Inferior Cerebellar Artery Aneurysm with Chiari Type i Malformation: Case Report

Justin R Mascitelli, Sharona Ben-Haim, Srinivasan Paramasivam, Hekmat K. Zarzour, Robert J. Rothrock, Joshua B. Bederson

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

BACKGROUND AND IMPORTANCE: Distal extracranial posterior inferior cerebellar artery (PICA) aneurysms are very rare lesions and have not been previously reported in association with a Chiari type I malformation (CMI). CLINICAL PRESENTATION: A 56-year-old woman with a distal, low-lying, intradural-extracranial PICA aneurysm presented with a subarachnoid hemorrhage and was treated with coil embolization. The patient presented again 1 month later with symptoms of a CMI and was found to have tonsillar herniation and a large syrinx that appeared to be exacerbated by the coil mass. The patient was re-treated with a suboccipital craniectomy, C1-2 laminectomy, aneurysm trapping and excision, end-to-end PICA anastomosis, and expansile duraplasty. CONCLUSION: Although just a single case, important teaching points regarding the angiographic appearance of a CMI and treatment options for distal PICA aneurysms that are situated below the foramen magnum can be learned. A low-lying caudal PICA loop should trigger a workup for a CMI. Caution should be taken when using coil embolization for aneurysms in the high cervical spinal canal. Bypass with aneurysm trapping and excision may be a superior treatment option in these cases because the posterior fossa and high cervical canal can be concomitantly decompressed. To our knowledge, this is the only case reported of a distal intradural-extracranial PICA aneurysm associated with a CMI. ABBREVIATIONS: CMI, Chiari type I malformation FM, foramen magnum PICA, posterior inferior cerebellar artery SAH, subarachnoid hemorrhage .

Original languageEnglish (US)
Pages (from-to)E660-E665
JournalNeurosurgery
Volume77
Issue number4
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • Bypass
  • Chiari malformation
  • Coiling
  • KEY WORDS: Aneurysm
  • PICA

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Association of a Distal Intradural-Extracranial Posterior Inferior Cerebellar Artery Aneurysm with Chiari Type i Malformation: Case Report'. Together they form a unique fingerprint.

Cite this