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Vol. 18. Issue 3.
Pages 232-237 (January 2007)
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Vol. 18. Issue 3.
Pages 232-237 (January 2007)
Aneurisma disecante de la arteria cerebelosa posteroinferior
Dissecting aneurysm of the posterior cerebellar artery
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1899
J.J. Rivas
, J. Domínguez, P. Bravo, J. Pérez, A.P. Avila
Servicio de Neurocirugía. Hospital Nuestra Señora de la Candelaria. Santa Cruz de Tenerife
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Resumen

Los aneurismas disecantes que afectan de forma exclusiva a la arteria cerebelosa posteroinferior (PICA) son muy raros. Su manifestación clínica dependerá del lugar de la pared arterial en que se produzca la disección, produciendo hemorragia subaracnoidea (HSA) o bien oclusión del vaso e isquemia. El diagnóstico del aneurisma se realiza en el estudio angiográfico mostrándose como una dilatación fusiforme de la arteria o como grados variables de estrechamiento y dilatación del vaso. La resonancia magnética (RM) puede ser de gran ayuda detectando el hematoma intramural.

Presentamos un enfermo de 47 años que sufrió una HSA que toleró bien. El estudio angiográfico mostró una dilatación fusiforme de la porción anterobulbar de la PICA. El paciente fue intervenido realizándose una exclusión del segmento de la PICA afecto, colocando un clip proximal y otro distal al aneurisma. El postoperatorio transcurrió sin incidencias a pesar de presentar en la angiografía de control un vasoespasmo muy notable de todo el territorio vertebrobasilar.

Los aneurismas disecantes de la PICA y fundamentalmente los que se presentan con HSA deben se tratados a fin de prevenir el resangrado. Tanto los procedimientos quirúrgicos como los endovasculares se han revelado eficaces y con buenos resultados.

Palabras clave:
Aneurisma disecante
Arteria cerebelosa posteroinferior
Hemorragia subaracnoidea
Tratamiento endovascular
Tratamiento quirúrgico
Abreviaturas:
AICA
HSA
MRI
PICA
RM
SAH
TC
Summary

Dissecting aneurysms affecting exclusively to the posterior inferior cerebellar artery (PICA) are rare entities. Depending on the dissecting plane of the arterial wall, the clinical manifestations are subarachnoid hemorrhage (SAH) due to rupture or ischemia caused by stenosis or occlusion. Angiographic findings are fusiform dilatation with a narrowing of various degrees proximal to and distal to the fusiform lesion. Magnetic resonance imaging (MRI) can be useful demonstrating the intramural hematoma.

We report a 47-year-old man who suffered from SAH. He was neurologicaly intact and vertebral angiography demonstrated and fusiform aneurysm at the origin of the left PICA.

He was operated by trapping of the dissecting segment. The patient's postoperative course was uneventful despite of severe vasospasm showed in follow up angiography.

Aggressive treatment has been recommended for dissecting aneurysms of the PICA and specially for those presenting with SAH. Both the surgical and endovascular procedures are effective and with good results.

Key words:
Dissecting aneurysm
Posterior inferior cerebellar artery
Subarachnoid hemorrhage
Endovascular therapy
Aneurysm surgery

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