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Department of Neurosurgery, Hakodate Central Hospital, Hakodate, Hokkaido, Japan. yama-shu@med.hokudai.ac.jp
A 73-year-old woman presented with diffuse subarachnoid hemorrhage from a ruptured fusiform aneurysm directly arising from the right distal anterior inferior cerebellar artery. Six years before admission, she had undergone stereotactic irradiation for right vestibular schwannoma, under a diagnosis based on neuroimaging. The aneurysm was located within the radiation field. We performed trapping and resection of the aneurysm via a right lateral suboccipital craniotomy, and the patient made a good recovery. Histological examination revealed no evidence of elastic lamina in the aneurysm wall, suggesting pseudoaneurysm caused by radiation-induced vascular injury. Aneurysm formation after radiotherapy is relatively rare and often manifests as fatal hemorrhage. Long-term surviving patients who have received intracranial irradiation should undergo sequential follow up for possible vascular involvement.
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