Selective n-Butyl Cyanoacrylate Embolization of a Ruptured Aneurysmal Lesion Arising from a Rete-like Collateral Network of the Posterior Inferior Cerebellar Artery
- 1Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
Abstract
A 58-year-old woman presented with sudden-onset severe headache and decreased consciousness. Computed tomography revealed posterior fossa–predominant subarachnoid hemorrhage. Digital subtraction angiography demonstrated a rete-like collateral network of the left posterior inferior cerebellar artery, an extremely rare vascular anomaly in which the posterior inferior cerebellar artery trunk divides into a plexiform network of small dysplastic channels before reconstituting into distal branches. A 1.5-mm aneurysmal lesion was identified on one channel of this network by superselective angiography and was considered the bleeding source; given its small size and the fragile dysplastic substrate, a pseudoaneurysm could not be excluded. After emergent hematoma evacuation, the aneurysm-bearing channel was selectively occluded with 25% n-butyl cyanoacrylate (0.2 mL). Post-embolization angiography confirmed exclusion of the lesion with preserved distal posterior inferior cerebellar artery perfusion through the remaining channels. Diffusion-weighted imaging at 48 hours showed no new ischemic lesions in the posterior inferior cerebellar artery perfusion territory. The patient was discharged with a modified Rankin Scale score of 2, which improved to 1 at 7 months. A rete-like collateral network of the posterior inferior cerebellar artery is exceedingly rare. Although a ruptured pseudoaneurysm on a hypoplastic and plexiform posterior inferior cerebellar artery has been reported, a ruptured aneurysmal lesion arising from a focal rete-like collateral network of an otherwise normal posterior inferior cerebellar artery, treated by selective channel occlusion, has not previously been described. The multi-channel architecture of this anomaly may permit selective occlusion of an aneurysm-bearing channel while maintaining distal perfusion; however, the potential risk of brainstem perforator infarction must be carefully considered, and further experience is needed before this strategy can be generalized.
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BibTeX
@article{saito2026selective,
title = {{Selective n-Butyl Cyanoacrylate Embolization of a Ruptured Aneurysmal Lesion Arising from a Rete-like Collateral Network of the Posterior Inferior Cerebellar Artery}},
author = {Akira SAITO and Tomoko IKEMOTO and Shunya HANAKITA and Satoshi IIHOSHI},
journal = {NMC Case Report Journal},
year = {2026},
month = oct,
doi = {10.2176/jns-nmc.2026-0226},
url = {https://doi.org/10.2176/jns-nmc.2026-0226},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Selective n-Butyl Cyanoacrylate Embolization of a Ruptured Aneurysmal Lesion Arising from a Rete-like Collateral Network of the Posterior Inferior Cerebellar Artery
AU - Akira SAITO
AU - Tomoko IKEMOTO
AU - Shunya HANAKITA
AU - Satoshi IIHOSHI
PY - 2026
DA - 2026/10/13
JO - NMC Case Report Journal
DO - 10.2176/jns-nmc.2026-0226
UR - https://doi.org/10.2176/jns-nmc.2026-0226
AB - A 58-year-old woman presented with sudden-onset severe headache and decreased consciousness. Computed tomography revealed posterior fossa–predominant subarachnoid hemorrhage. Digital subtraction angiography demonstrated a rete-like collateral network of the left posterior inferior cerebellar artery, an extremely rare vascular anomaly in which the posterior inferior cerebellar artery trunk divides into a plexiform network of small dysplastic channels before reconstituting into distal branches. A 1.5-mm aneurysmal lesion was identified on one channel of this network by superselective angiography and was considered the bleeding source; given its small size and the fragile dysplastic substrate, a pseudoaneurysm could not be excluded. After emergent hematoma evacuation, the aneurysm-bearing channel was selectively occluded with 25% n-butyl cyanoacrylate (0.2 mL). Post-embolization angiography confirmed exclusion of the lesion with preserved distal posterior inferior cerebellar artery perfusion through the remaining channels. Diffusion-weighted imaging at 48 hours showed no new ischemic lesions in the posterior inferior cerebellar artery perfusion territory. The patient was discharged with a modified Rankin Scale score of 2, which improved to 1 at 7 months. A rete-like collateral network of the posterior inferior cerebellar artery is exceedingly rare. Although a ruptured pseudoaneurysm on a hypoplastic and plexiform posterior inferior cerebellar artery has been reported, a ruptured aneurysmal lesion arising from a focal rete-like collateral network of an otherwise normal posterior inferior cerebellar artery, treated by selective channel occlusion, has not previously been described. The multi-channel architecture of this anomaly may permit selective occlusion of an aneurysm-bearing channel while maintaining distal perfusion; however, the potential risk of brainstem perforator infarction must be carefully considered, and further experience is needed before this strategy can be generalized.
SN - 2188-4226
ER -