Traumatic posterior inferior cerebellar artery pseudoaneurysm treated by trapping and OA-PICA bypass: A Case Report

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  • Trapping + OA-PICA bypass を施行した後下小脳動脈外傷性仮性動脈瘤の1 例

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<p>Traumatic pseudoaneurysms of the posterior inferior cerebellar artery (PICA) are rare. Here we report a pseudoaneurysm developed on the PICA after blunt head injury. A 35-year-old man hit the back of his head on the wall in a fight, and was admitted to our hospital. The computed tomography (CT) showed subarachnoid haemorrhage (SAH) at the foramen magna and an intraventricular hematoma accompanied by an acute hydrocephalus. 3D-CT angiography on admission did not show any aneurysm or other vascular abnormality. However, the left vertebral angiogram (Lt. VAG), 6 h after injury, revealed a saccular aneurysmal formation on the PICA slowly stained by pooled contrast medium, indicating a pseudoaneurysm. The patient underwent trapping and occipital artery-PICA (OA-PICA) bypass through a midlateral suboccipital approach. The bleeding point was identified as the laceration on the vessel wall of the lateral medullary segment of PICA surrounded by thick hematoma. Thus, the diagnosis was a pseudoaneurysm caused by the blunt head injury. Although the development of a traumatic pseudoaneurysm is usually delayed, this suggested that a pseudoaneurysm could be a different diagnosis of an acute traumatic SAH.</p>

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