Management of posterior inferior cerebellar artery aneurysms: What factors play the most important role in outcome?

Sejkorová, Alena; Petr, Ondra; Mulino, Miriam; Cihlář, Jiří; Hejčl, Aleš; Thomé, Claudius; Sameš, Martin; Lanzino, Giuseppe

doi:10.1007/s00701-016-3058-z

Cited by 19 publications

(17 citation statements)

References 21 publications

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“…We believe that the need for routine resection of the posterior arch of the atlas to approach the aneurysms of VA and PICA proposed by several authors[4,8,23,24] is somewhat dramatized. In fact, it necessary for the microsurgical approach to VAprox aneurysms and low PICAprox aneurysms.…”

Section: Discussionmentioning

confidence: 99%

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Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Pilipenko¹,

Eliava²,

Okishev³

et al. 2019

Surgical Neurology International

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Background: The choice of surgical approaches and options for the microsurgical vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms repair remains controversial. Methods: A retrospective analysis of the clinical, surgical, and angiographic data of 80 patients with VA and PICA aneurysms treated from 2012 to 2018 was performed. Results: The aneurysms were saccular in 50 cases (62.5%) and fusiform in 30 cases (37.5%). The median suboccipital craniotomy was the most common approach (73.8%). Retrosigmoid craniotomy was performed in 25% of patients. There were the following types of microsurgical operations: neck clipping (61.25%), clipping with the artery lumen formation (13.75%), trapping (10%), proximal clipping (5%), and deconstruction with anastomosis (10%). Fifty-seven (71.3%) patients were discharged without worsening of the clinical signs after surgery. The most common postoperative neurological disorder was palsy of IX and X cranial nerve revealed in 14 (17.5%) patients. No fatal outcomes or patients in vegetative state were identified. The complete occlusion of PICA and VA aneurysms according angiography was in 77 (96.3%) cases. Conclusion: Microsurgical treatment is an effective method for VA and PICA aneurysms. The majority of VA and PICA aneurysms do not require complex basal approaches. A thorough preoperative planning, reconstructive clipping techniques, and anastomoses creation, as well as patient selection based on the established algorithms and consultations with endovascular surgeons, may reduce the number of complications and increase the rate of complete microsurgical occlusion in VA and PICA aneurysms.

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Section: Discussionmentioning

confidence: 99%

“…The choice of treatment for VA and PICA aneurysms (microsurgical or endovascular surgery) remains controversial. [3,5,21,23,25,26]…”

Section: Introductionmentioning

confidence: 99%

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Pilipenko¹,

Eliava²,

Okishev³

et al. 2019

Surgical Neurology International

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“…According to a retrospect analysis of cases with PICA aneurysms from 3 centers, the recurrence rate of endovascular management is 14.7% and procedure-related complications happened in 11.8% patients. [8]…”

Section: Discussionmentioning

confidence: 99%

“…[7] And SAC was reported to have higher recurrence rate. [8] Furthermore, SAC could not be practiced easily when facing dissecting or wide-neck aneurysm or twist patent artery.…”

Section: Introductionmentioning

confidence: 99%

Endovascular management of ruptured distal posterior inferior cerebellar artery aneurysms

Chen¹,

Sun²,

Shi³

et al. 2018

Medicine

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Distal posterior inferior cerebellar artery (PICA) aneurysm is a kind of rare intracranial aneurysm with controversial evidence in managements. The main purposes of this research are to study the safety and effectiveness of parent artery occlusion (PAO) compared with selective aneurysm coiling (SAC) as well as figure out factors that affect the outcomes.All characteristics of patients that diagnosed with ruptured distal PICA aneurysm and treated with endovascular management in our hospital from July 2009 to February 2016 were retrospectively collected. Details include complete occlusion rate, procedure-related complications and Modified Rankin Scale (mRS) of 31 months (mean) follow-up.Total 36 patients finally met the criterions and were included in the present study. New imaging infarction was observed in 12 (33.33%) patients. And 10 of them showed no apparent neurological dysfunctions after 34 months (mean) follow-up; 1 remained coma status since the symptom onset; and 1 patient died. 27 (75%) patients got a mRS ≤ 2 at the discharge while 20 (86.96%) patients with 3-year follow-up after the operation. There is no significant difference between patients treated with SAC and PAO in both complications and functional recovery in 3-years follow-up period. Hunt&Hess classification (H&H), age, and hydrocephalus are risk factors for functional recovery at discharge.PAO is safe and efficient in the management of distal PICA aneurysms while complications and outcomes are similar with SAC. H&H, age, and hydrocephalus are predicting factors for the mRS at discharge. Further prospective study is still needed to confirm the results of present study.

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“…36 Bohnstedt et al 37 published the largest series so far, valuing both microsurgical and endovascular treatments of 102 PICA aneurysms and have favored microsurgical clipping over coiling. Sejkorová et al 38 also reported their series of 81 cases of PICA aneurysms during a 15-year period and found more recurrences in the coiled group. A meta-analysis by Petr et al 39 of 796 PICA aneurysmal cases comparing clipping and coiling has shown PICA Aneurysms: An Overview Deora et al…”

Section: Endovascular Versus Clippingmentioning

confidence: 90%

Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature

Deora

Nayak

Dixit

et al. 2020

JNRP

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Background Posterior inferior cerebellar artery (PICA) is a tortuous, variable, and uncommon site for aneurysms. Surgical management of PICA aneurysms involves careful selection of approach based on the location of the aneurysm and meticulous dissection of the neurovascular structures and perforators. Materials and Methods We did a retrospective review of all the PICA aneurysms operated at our institute in the past 10 years along with the site, presentation, and approach used for the same. Preoperative World Federation of Neurosurgical Society scores and follow-up modified Rankin scores (mRS) were also evaluated. During the same period, data for intervention cases of PICA aneurysm were also collected with follow-ups for a comparative analysis. Results A total of 20 patients with 21 PICA aneurysms were reviewed. All the reviewed cases presented with subarachnoid hemorrhage, and the most common location was the lateral medullary segment and vertebral artery (VA)–PICA junction. Midline approaches were used for distal PICA cases, with far-lateral approach reserved for anterior medullary/VA–PICA junction. No lower cranial nerve palsies were recorded at follow-up. Four cases needed cerebrospinal fluid diversion and two developed cerebellar infarcts. All cases were mRS 0 to 2 at follow-up. Conclusion Our series compares well with some of the larger surgical series of PICA aneurysms. This may be due to early referral patterns and early surgery (<24 hours) policy at our institution. Anatomical knowledge of PICA anatomy and sound perioperative management are keys to good outcomes in these cases.

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Management of posterior inferior cerebellar artery aneurysms: What factors play the most important role in outcome?

Abstract: This study of PICA aneurysms demonstrates that results of both treatment modalities are comparable. However, endovascular treatment is associated with higher risks of recurrence, requiring additional treatment. Outcomes were mostly impacted by clinical state at admission.

Cited by 19 publications

References 21 publications

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Endovascular management of ruptured distal posterior inferior cerebellar artery aneurysms

Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature

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