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Choroidal Artery Aneurysms of the Posterior Inferior Cerebellar Artery Presented with Fourth Ventricular Hemorrhage : report of 2 cases Shigetaka ANEGAWA 1 , Takashi HAYASHI 1 , Ryuichiro TORIGOE 1 , Hiroaki HIGASHIOKA 1 , Masashi TOMOKIYO 1 , Tetsuzo OGASAWARA 1 1Department of Neurosurgery, Institute of Neurosciences, St. Mary's Hospital Keyword: choroidal artery , cerebral aneurysm , embryology , hemodynamic stress pp.729-735
Published Date 1998/8/10
DOI https://doi.org/10.11477/mf.1436901605
  • Abstract
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Two cases involving a ruptured aneurysm in a choroidal branch of the posterior inferior cerebellar arteryare reported here.

Case 1: A 61-year-old woman was admitted after an episode of severe headache with persistent vomit-ing. A CT revealed an intraventricular hemorrhage within the fourth ventricle. An angiography showed ananeurysmal shadow in the choroidal artery branching from the telovelotonsillar segment of the distal pos-terior inferior cerebellar artery (PICA). The operation disclosed a fusiform aneurysm in the choroidalartery which was successfully trapped using Yasargil's mini-clips. The postoperative course was uneventfuland the patient was discharged without any neurological deficit.

Case 2: A 64-year-old woman became unresponsive after complaining of a severe headache. On admis-sion, she was semicomatose with positive bilateral Babinski's sign. A CT scan showed that the fourth andthird ventricles were packed and dilated by a massive hematoma. An angiography demonstrated ananeurysmal shadow in a branch from the PICA with an occlusion of the right vertebral artery. Further-more, the left vertebral artery was also occluded and the basilar artery was fed by collateral circulation.The patient underwent an operation immediately. The fusiform aneurysm was resected after ligation. Herpostoperative course was satisfactory. She was able to go home without neurological deficit. There hasbeen only one article about “pure” choroidal artery aneurysm, reported by Uranishi, et. al in 1994. Theysuggested that the pathogenesis of this lesion could be due to hemodynamic stress. Our two cases also pre-sent the same characteristics, in the shape of the aneurysms as well as in the anomalous structures in theposterior circulation. Our results offer further evidence concerning the pathogenesis of that type of lesion.


Copyright © 1998, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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