A 39 year-old male without past notable medical history was admitted with a sudden headache and neck stiffness. Brain computed tomography (CT) demonstrated evidence of Fisher Grade III subarachnoid hemorrhage (SAH) predominance of the pre-pontine, left ambient and quadrigeminal cistern (), and a fusiform aneurysm of a left distal SCA was revealed on the CT angiography (). Subsequent digital subtraction angiography (DSA) revealed the fusiform dilatation (12 mm length; 4.5 mm width) involving the ambient segment of the left distal SCA. The left SCA was duplicated ahead of the aneurysm and there was sufficient collateral circulation from the ipsilateral anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) (). The aneurysm was treated by endovascular occlusion of the aneurysm sac and the involved branch. Under general anesthesia an Excelsior SL-10 microcatheter was used to access the aneurysm. Seven detachable platinum coils were used to obliterate the lesion. Post-procedural angiography showed complete occlusion of the aneurysm sac and involved the SCA branch (). There was no immediate complication after embolization. Diffusion MRI was done 8 hours after embolization. MRI revealed scattered high signal change on the left posterior tegmentum, superior vermis, and superior part of the left cerebellum (). Left sixth nerve palsy occurred in the patient 1 day after EVT. The symptom completely recovered within 1 week of the post-procedural period. No neurological deficit was seen during the clinical 3-month follow-up.
A 50-year-old lady, who had a history of hypertension, presented with severe headache and ataxia. CT scan done at admission showed acute right cerebellar hematoma []. DSA done subsequently revealed fusiform aneurysm of the cisternal segment of the SCA []. Endovascular treatment was done under general anesthesia with inside out coiling of the aneurysm with platinum coils []. Standard heparin protocol was followed and an activated clotting time greater than 250 s was maintained during the procedure. 5F Envoy (cordis) guiding catheter was placed in the distal vertebral artery. A combination of echelon-10 micro-catheter (ev3) and transcend 0.014 micro-wire (Stryker) were used to access the aneurysms and multiple axiom (ev3) coils were used to occlude the aneurysm. Post-coiling angiogram showed complete exclusion of the aneurysm from the circulation. The post-operative period was uneventful. The patient's neurological examination done after 1 month was completely normal. Control angiogram done at the end of 1 year showed stable occlusion with no re-canalization of the aneurysm [].