Background: Stereotactic radiosurgery (SRS) is an established modality for treatment of vestibular schwannomas (VSs). However, its long-term vascular complications have not been well studied. Among 360 patients who underwent SRS for VS in our institution and lived for >5 years thereafter, we identified only 1 patient who exhibited a complication secondary to a late-onset aneurysm for an estimated incidence of 0.3%.
Case description: A 78-year-old man who had undergone SRS 19 years previously for a right VS presented with right peripheral facial palsy. Radiographic examinations revealed a distal anterior inferior cerebellar artery (AICA) fusiform aneurysm that was embedded in the tumor and progressively enlarged over 17 months. Although the right AICA perfused a large area of the cerebellum, the aneurysm was successfully treated with AICA trapping in conjunction with an occipital artery-AICA bypass.
Conclusions: Distal AICA pseudoaneurysm formation is a rare but potentially severe late complication after SRS for VS. This pathology was successfully treated with AICA trapping with occipital artery-AICA bypass.
Keywords: Anterior inferior cerebellar artery; Occipital artery–anterior inferior cerebellar artery bypass; Pseudoaneurysm; Stereotactic radiosurgery; Vestibular schwannoma.
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