Abstract
An aneurysm of the distal anterior inferior cerebellar artery (AICA) is extremely rare. The authors report the case of the ruptured AICA-internal auditory artery (IAA) junction aneurysm, and review the literatures, with a focus on the surgical strategies for treating this aneurysm. A 72-year-old woman presented with sudden onset of severe headache and hearing disturbance. Computed tomography revealed a subarachnoid hemorrhage and magnetic resonance imaging (a heavily T2-weighted image) revealed that the dome of the aneurysm was in the right internal auditory meatus. Cerebral angiography revealed a saccular aneurysm at the meatal loop of the right AICA. An emergency operation was performed through the right suboccipital approach. We confirmed that a 5 mm aneurysm had formed, and that it was located between the facial and acoustic nerves. At the sacrifice of the acoustic nerve and IAA, the aneurysm was completely clipped using 2 Sugita's clips. The distal circulation of the AICA was preserved. In the literature, most cases of ruptured AICA-IAA aneurysms present with facial or/and acoustic nerve deficits. When performing surgery for these types of aneurysms, it is difficult to preserve the acoustic nerve and to recover functional hearing. Therefore, surgeons should give priority to managing the ruptured aneurysm, and to preserving the facial nerves.
