Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms

Abstract

Aneurysms located on the posterior inferior cerebellar artery are rare, and treatment guidelines for them have not yet been established. In this paper, we present the results of a retrospective study which analyzes the management and treatment of 15 patients with posterior inferior cerebellar artery aneurysms from 2004 to 2013. The aneurysms were ruptured and presented with a subarachnoid hemorrhage. Of the 15 aneurysms, ten were of saccular, three fusiform, and two were dissecting. Computed tomography angiography or digital subtraction angiography revealed other aneurysms or intracerebral artery hypoplasia in seven patients. Either surgical or endovascular treatment was performed depending on the localization and morphology of the aneurysm. Six aneurysms were coiled, and surgery was performed in nine cases. Of the nine surgically treated patients, six (75%) had good outcomes. Of the six patients treated using endovascular procedures, three patients (50%) recovered. Patient outcomes were classified using the Hunt&Hess scale. Patients with Hunt&Hess 1-3 recovered without a neurological deficit. On the other hand, patients with Hunt&Hess 4-5 had a risk of up to 93% of death or a poor outcome. In two cases of endovascular and in two cases before any therapy, aneurysmal rebleeding occurred and resulted in deterioration of clinical state of the patient and a poor prognosis with high risk of death. This study shows the necessity of acute treatment of posterior inferior cerebellar artery aneurysm, of thorough diagnostic, and of interdisciplinary cooperation.

Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

“…The articles which were excluded from that article pool were those which focused on the reoperation management, case reports, systematic reviews, unrelated outcome, co-morbidities, experimental techniques, or one of the two techniques and all those which demonstrated mixed or unclear results, being separated between anterior and posterior circulation. The final article pool contained 20 articles, as appropriate for our meta-analysis [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Fig. 1).…”

A Case of Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysm Treated with Intra-aneurysmal Coil Embolization

“…The general sites of PICA aneurysms are classified as follows: 1) the anterior medullary segment, 2) lateral medullary segment, 3) tonsillomedullary segment, 4) telovelotonsillar segment, and 5) cortical segment. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] On the basis of this classification, we evaluated the factors to be considered while selecting the treatment methodology.…”

“…6) Our patient also showed a rapid decline in the level of consciousness accompanied by marked intraventricular hematoma after rupture, suggestive of a rapid increase in posterior cranial fossa pressure, as described in previous reports. In addition, Sejkorová et al 15) reported that ruptured distal PICA aneurysms should be treated early after the onset because the re-rupture rate before treatment was found to be higher for these aneurysms as compared to aneurysms at other sites, such as supratentorial aneurysms. In the present case, considering the risk of hemorrhagic complications due to systemic heparinization during the endovascular treatment, we performed ventricular drainage after the endovascular treatment.…”

“…8,10,15) Conventional direct surgery is advantageous because the properties of the aneurysm can be directly examined, regardless of its location, 8) and early decompression can be achieved by removing the hematoma and draining the cerebrovascular fluid during the surgery. 7,8,10) However, one study reported that aggressive treatment for hydrocephalus via ventricular drainage before endovascular treatment resulted in favorable outcomes.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The number of reports on the use of endovascular treatments for PICA aneurysms has increased recently; however, an endovascular procedure should be selected after individual patient assessment as the PICA has several anatomical variations, has a small diameter, and has considerable tortuosity. In the case presented here, we treated a distal PICA aneurysm accompanied by subarachnoid hemorrhage by performing intra-aneurysmal coil embolization while preserving the parent artery.…”