Surgical treatment of distal aneurysms on superior cerebellar artery: two case reports

Distal aneurysms of the superior cerebellar arteries (SCA) present a rare subgroup of intracranial aneurysms. Only few case reports describe this condition. Therefore, the surgical approach to treating distal SCA aneurysms remains controversial. We are demonstrating surgical treatments of previously unavailable, distal SCA aneurysms as a number of multimodal case reports. We describe two different ways to treat two patients with distal SCA aneurysms and provide a literature review. First, a 38-year-old patient presented with an acute subarachnoid ventricular hemorrhage due to distal SCA aneurysm rupture. Microsurgical clipping of the aneurysm was performed. Then the aneurysm ruptured intraoperatively, which required temporary clipping of the SCA trunk. The postoperative period was complicated by a progressive and eventually lethal cerebral angiospasm. Another, 36-year-old female patient was admitted in acute condition after recurrent ruptures of a distal SCA aneurysm associated with subarachnoid parenchymal hemorrhage. The patient underwent endovascular SCA deconstruction at the aneurysm level. No complications or neurological symptoms were observed postoperatively. The patient was discharged for outpatient treatment on day 4. Endovascular surgery should be considered as a method of choice for ruptured distal SCA aneurysms. Microsurgical intervention may be an option when endovascular repair is impossible and when other surgical procedures such as removal of hematoma and prevention of occlusive hydrocephalus are required.