Ruptured Anterior Inferior Cerebellar Artery (AICA) Aneurysm Presenting with Cranial Nerve Deficits: Case report and Management Overview
Boris Kobilja1, Jonathon Lebovitz2, David Penn3
1Neurology, Northwell Health, 2Neurosurgical Associates of Southwestern CT, 3Northwell health
Objective:
To present a case of ruptured AICA aneurysm in a patient with acute left facial paralysis, unilateral hearing loss, and posterior neck pain, and to discuss neuro-interventional and neurosurgical challenges in management.
Background:
AICA aneurysms are exceptionally rare cerebral aneurysms, representing less than one percent of all cerebral aneurysms. Rupture can be devastating, causing subarachnoid hemorrhage, brainstem compression and cranial nerve deficits. Urgent recognition and treatment are imperative.
Results:
A 47-year-old man with a past medical history of hypertension and hyperlipidemia presented to the emergency department with left facial paralysis, left sided hearing loss, and posterior neck pain radiating behind the ears. Blood pressure was elevated to 190s/110s on arrival. CT head was remarkable for subarachnoid hemorrhage in the left cerebellopontine angle and CTA head revealed a 7 mm aneurysm in the left internal auditory canal. The patient was taken directly for diagnostic cerebral angiogram and attempted embolization of the aneurysm which was unsuccessful. Ultimately, the decision was made for neurosurgical clipping via a combined transmastoid, retrosigmoid approach which required complex clip placement techniques for cranial nerve preservation. He recovered well from the procedure and was discharged home on postoperative day thirteen. At 3 month follow-up, he had improved hearing and facial function compared to presentation. Three month post-op follow-up MRA head showed no signs of recurrent or residual aneurysm.
Conclusions:
Ruptured AICA aneurysms within the internal auditory canal present unique diagnostic and technical challenges. Endovascular navigation is limited by the small caliber and tortuosity of the AICA especially when attempting to preserve parent arteries. Meanwhile skullbase access for aneurysm clipping requires complex neurosurgical approaches to preserve cranial nerve function. Post-op recovery requires neurocritical care monitoring. Therefore, multidisciplinary management is essential for optimal patient recovery.
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