![]() Multiplanar postgadolinium T1-weighted images were acquired at a 3- to 5-mm section thickness with a 0- or 1-mm gap, with or without a fat-saturation technique. ![]() Typically, axial T2-weighted images were obtained by using an FSE or TSE technique at section thicknesses ranging from 2.5 to 5 mm, with a 0- or 1-mm gap. MR imaging techniques varied slightly among the patients, depending on the location of their scans and whether the brain examinations were modified for inclusion of imaging of the face to evaluate facial hemangiomas. A neuroradiologist with 9 years of experience and a pediatric neuroradiologist with 20 years of experience performed a consensus review of MR imaging examinations of the brain from pediatric patients with an established diagnosis of PHACES association based on accepted clinical criteria. Institutional review board approval was obtained from the 2 participating institutions for this retrospective review. Subsequent review of clinical data bases at 2 institutions identified 44 patients (37 male, 7 female) diagnosed with PHACES association who underwent diagnostic MR imaging of the brain between 20. We raise the possibility of an association between enlargement of the internal auditory canal in PHACES and a generalized malformation of the posterior fossa with cerebellar and calvarial hypoplasia. Imaging was reviewed for abnormal enhancement in the internal auditory canal, internal auditory canal enlargement, cerebellar hypoplasia, prominence of the petrous ridge, and deformity of the calvarium. We reviewed our records to identify children with PHACES association who had been evaluated with MR imaging at our institutions. Some reports suggested that hemodynamic stress caused by AVM, hemangioblastoma, or vascular anastomosis could be a mechanism for the development of distal AICA aneurysm 8).SUMMARY: We noted enlargement of the internal auditory canal in several of our patients with posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, and sternal or supraumbilical defects (PHACES) association and hence evaluated children with PHACES for the presence of an enlarged internal auditory canal and potential associated findings, including infantile hemangioma within the internal auditory canal, to understand the genesis of this enlargement. The pathological nature of this aneurysm is also unclear 3). Interestingly, most of the reported cases, including the current case, occurred in women without any known explanation. This group of aneurysms has certain features : 1) SAH occurs in most cases because of aneurysm rupture 2) tight adhesion to the surrounding structures including the nerve complex and 3) postoperative hearing function is likely to be seriously impaired 9). Total intrameatal aneurysms are type III meatal aneurysms and are extremely rare only 17 cases have been reported in the literature as of 2012 3). Meatal aneurysms are subdivided into 3 types according to Yamakawa's classification system : type I (remote type : aneurysm away from the meatus, 56%), type II (plugged : aneurysm partially buried in the meatus, 30%), and type III (buried : entirely buried in the meatus, 14%). 1) classified this aneurysm into 3 types : proximal, meatal, and distal. 4) reported that among 3500 surgically treated aneurysms, only 1.7% arose from the AICA. After operation the patient experienced transient facial paresis and tinnitus but improved during follow up.ĪICA aneurysms are very rare. The aneurysm was identified between the seventh and eighth cranial nerve in the meatus and was removed from the canal and clipped with a small straight Sugita clip. Surgery was performed by retrosigmoid craniotomy with unroofing of the internal auditory meatus. Computed tomography and digital subtraction angiography showed subarachnoid hemorrhage at the basal, prepontine cistern and an aneurysm of the distal anterior inferior cerebellar artery inside the internal auditory meatus. A 62-year-old female patient presenting with sudden bursting headache and neck pain was transferred to our department. The authors report a case of surgically treated total intrameatal AICA aneurysm. Among the distal anterior inferior cerebellar artery (AICA) aneurysms, a unique aneurysm at the meatal loop inside the internal auditory meatus is extremely rare.
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