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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 651-655
DOI: 10.1055/s-0042-1757432
Case Report

Endovascular Embolization with n-Butyl Cyanoacrylate for Ruptured Distal Posterior Inferior Cerebellar Artery Dissecting Aneurysm

Ryosuke Shintoku 
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Aiki Marushima
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Sho Okune
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Takato Hiramine
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Junzo Nakao
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Toshihide Takahashi
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Tenyu Hino
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Hisayuki Hosoo
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Yoshiro Ito 
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
,
Mikito Hayakawa
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
3   Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
,
Eiichi Ishikawa
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
,
Yuji Matsumaru
1   Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
2   Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan
3   Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Abstract

Parent artery occlusion is a definitive treatment method for preventing rebleeding of dissecting aneurysms. We herein report a case of a ruptured distal posterior inferior cerebellar artery (PICA) dissecting aneurysm treated with internal trapping using n-butyl-2-cyanoacrylate (NBCA). A 65-year-old man visited our hospital with a complaint of headache and neck pain that began 1 week before his arrival. He had a history of spontaneous subarachnoid hemorrhage of unknown cause. Computed tomography of the brain revealed a small amount of subarachnoid hemorrhage, and distal subtraction angiogram showed a distal PICA dissecting aneurysm. We placed a guiding catheter in the left vertebral artery and an intermediate catheter in the PICA. A microcatheter was guided toward the proximal side of the aneurysm and was wedged into the parent artery. The dissecting aneurysm was treated with parent artery occlusion using 50% NBCA. The postoperative course was uneventful, and the patient was discharged 3 weeks after treatment without any neurological deficit. Parent artery occlusion with internal trapping using NBCA could be a safe and definitive treatment method for distal PICA dissecting aneurysms. Angiographical evaluation of the collateral network in the distal branch of PICA before embolization and wedged microcatheter technique in the parent artery are important for successful embolization using NBCA.

Keywords

angiographical collateral network - distal PICA dissecting aneurysm - n-butyl-2-Cyanoacrylate - parent artery occlusion - wedged microcatheter technique


Publication History

Article published online:
22 September 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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