Dissecting aneurysms of the posterior inferior cerebellar artery: retrospective evaluation of management and extended follow-up review in 6 patients
ABSTRACT The authors report the management protocol and successful outcomes in 6 patients with dissecting aneurysms of the posterior inferior cerebellar artery (PICA).
Medical records and neuroimaging studies of 6 patients who underwent surgical treatment of dissecting PICA aneurysms were reviewed. The mean follow-up duration was 1.8 years. No patient was lost to follow-up review.
Four patients presented with acute subarachnoid hemorrhage and 2 with PICA ischemia. All patients underwent surgery, which entailed proximal occlusion with distal revascularization in 3 cases and circumferential wrap/clip reconstruction in 3 cases. The revascularization techniques used were occipital artery-PICA bypass and PICA-PICA anastomosis. Delayed follow-up angiography was performed in all cases. In patients treated with proximal occlusion, delayed angiography showed minimal retrograde opacification of the dissected segments. The 3 patients treated with wrap/clip reconstruction showed unexpectedly significant normalization of their lesions on angiographic studies. Outcome was good in all cases.
Dissecting PICA aneurysms are rare lesions with an apparent propensity for bleeding. Individualized management including distal revascularization with PICA sacrifice or circumferential wrap/clip reconstruction to reinforce the dissected segment produced good outcomes. Patients treated with aneurysm wrapping may show dramatic angiographic improvement of the dissected segment.
Neurology India 01/2015; 63(1):105-106. DOI:10.4103/0028-3886.152671 · 1.08 Impact Factor
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ABSTRACT: Objective: The purpose of this study was to clarify the features of posterior inferior cerebellar artery (PICA) dissection. Materials and Methods: We prospectively registered 93 consecutive patients and 108 arteries with confirmed diagnoses of dissection in the vertebral artery (VA) or PICA between February 2007 and January 2014. Patients were diagnosed with arterial dissection when they had both acute symptoms and radiological characteristics in magnetic resonance imaging or digital subtraction angiography. Patients were divided into 2 groups depending on whether the site of dissection was VA (VA group) or PICA (PICA group). We compared the clinical and radiological characteristics and clinical outcomes of PICA versus VA dissection. Results: Of the 93 patients included in this study, 83 were in the VA group, and 10 had arterial dissection in the PICA. Patients with PICA dissection more frequently suffered from SAH (P < .001), whereas nonstroke symptom was often the initial symptom in the VA group. Pearl sign was seen most frequently at the dissection site of PICA. Surgical or endovascular treatment was performed in 9 of 10 PICA dissections, whereas more than half of the VA dissections were treated conservatively (P < .001). SAH was significantly more severe in the patients with PICA dissection compared with those in the VA group (P = .049). Conclusion: Patients with PICA dissection suffered from subarachnoid hemorrhage more frequently than those with VA dissection. PICA dissection was treated with surgical intervention, whereas VA dissection was treated conservatively.Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 09/2014; 23(10). DOI:10.1016/j.jstrokecerebrovasdis.2014.07.013 · 1.99 Impact Factor
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ABSTRACT: BACKGROUND: Selected intracranial aneurysms still require parent artery occlusion. Although such occlusion is usually performed proximal to the aneurysm, in rare instances, it may be difficult or impossible to access the proximal parent artery. OBJECTIVE: To describe the use of parent artery sacrifice distal to the aneurysm (distal outflow occlusion) in the management of complex aneurysms not amenable to standard microsurgical or endovascular therapy. METHODS: We reviewed a comprehensive database of intracranial aneurysms evaluated between 1997 and 2013. Hospital records, neuroimaging studies, operative reports, and outpatient clinic notes were examined for all patients treated with distal outflow occlusion. RESULTS: Eighteen patients (11 women, 7 men; ages 28-69 years) underwent surgical distal outflow occlusion. Eight (44%) underwent concomitant distal revascularization. Intraoperative and delayed postoperative angiography was performed in every case. Nine presented with acute subarachnoid hemorrhage, 1 had a remote bleeding episode. The remaining lesions were unruptured; 3 were discovered incidentally, 3 had symptomatic cerebral edema, 1 had transient ischemic attacks, and 1 had cranial neuropathy. The average follow-up period was 6.5 years; no patient was lost to follow-up review. Two aneurysms required delayed endovascular treatment. Overall, 16 patients achieved a good outcome, 1 had moderate disability, and 1 died. CONCLUSION: We describe our experience with distal outflow occlusion in the treatment of complex aneurysms not amenable to primary clip reconstruction or endovascular therapy. This technique has been described in very limited fashion in the past and may be particularly useful for patients requiring parent artery occlusion when proximal occlusion is challenging or impossible. ABBREVIATIONS: PICA, posterior inferior cerebellar artery SAH, subarachnoid hemorrhage Copyright (C) by the Congress of Neurological SurgeonsNeurosurgery 09/2014; DOI:10.1227/NEU.0000000000000572 · 3.03 Impact Factor