A Case of a Ruptured Aneurysm of the Long Circumfrex Branch Associated with a Tentorial Dural Arteriovenous Fistula

• Published in: Surgery for Cerebral Stroke Vol. 50; no. 3; pp. 212 - 217
• Main Authors: NISHII, Tomoya, UDA, Kenji, TAMARI, Yosuke, IZUMI, Takashi, HAYASHI, Shigemasa
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society on Surgery for Cerebral Stroke 2022
• Subjects: long circumflex branch; ruptured aneurysm; tentorial dural arteriovenous fistula
• ISSN: 0914-5508; 1880-4683
• DOI: 10.2335/scs.50.212

We report a case of subarachnoid hemorrhage in a 66-year-old man. A 3-mm aneurysm of the long circumflex branch of the P1 segment of the posterior cerebral artery was revealed by computed tomography angiography, and this was recognized as the bleeding source based on the hematoma distribution. In addition, the aneurysm was diagnosed as a flow-related aneurysm because the long circumflex branch was the main feeder of the tentorial dural arteriovenous fistula (dAVF). It was considered ideal to prevent re-rupture of the aneurysm and to treat the tentorial dAVF with simultaneous drainage occlusion by endovascular treatment. However, considering the shape of the aneurysm, preservation of the parent artery seemed to be difficult with endovascular treatment; therefore, only the ruptured aneurysm was treated by clipping first and then the tentorial dAVF was treated with endovascular treatment. The patient had a good clinical course without any complications. This case may be helpful in determining the ideal treatment in similar cases.