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.
SourceAvailable from: Jason Michael Frerich[Show abstract] [Hide abstract]
ABSTRACT: Aneurysms arising from PICA to PICA communicating collaterals are very rare. Only five cases have so far been described in the literature. Here, we report the first case with multiple aneurysms occurring on separate inter-PICA communicating collateral arteries, where one of the PICA’s was occluded proximally and reconstituted distally through the inter-PICA collateral arteries, in a patient presenting with subarachnoid hemorrhage. After standard management, the ruptured aneurysm was resected, and the other unruptured aneurysm was clipped. Side-to-side PICA-to-PICA anastomosis distal to the communicating collaterals was performed in order to maintain collateral circulation to the brain stem. Clinicians should be aware of the possibility of these rare aneurysms, and should consider in situ bypass in the management of PICA aneurysms where the aneurysm is proximal to the telovelotonsillary segment of PICA.
[Show abstract] [Hide abstract]
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
[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: Aneurysms of the posterior inferior cerebellar artery (PICA) distal to its origin are rare. Beside their rarity, their treatment is challenged by a high proportion of fusiform aneurysms, torturous course of PICA, and often severe bleeding. Our aim is to represent the characteristics of these aneurysms and their treatment, as well as to analyze outcome. METHODS: We reviewed retrospectively 80 patients with PICA aneurysms who were treated at the Department of Neurosurgery, Helsinki, Finland. RESULTS: The 80 patients had altogether 91 distal PICA aneurysms. Subarachnoid hemorrhage occurred in 74 (93%), and the distal PICA aneurysm was ruptured in 68 (85%). Compared with aneurysms at other locations, distal PICA aneurysms were smaller, more often fusiform, and more often caused an intraventricular hemorrhage as well as rebleeding. Modified surgical techniques (trapping, wrapping, proximal occlusion, resection, coagulation) were used in 10 (32%) fusiform and in 3 (6%) saccular aneurysms. Revascularization was needed in 3 (4%) cases. One aneurysm was primarily embolized. Within a year after aneurysm diagnosis, 18 patients had died. Among survivors, most returned to independent or previous state of living: 52 (91%); only 1 patient was unable to return home. CONCLUSIONS: Microsurgery is a feasible treatment for distal PICA aneurysms. Despite the challenge of often severe hemorrhage, wide-necked aneurysms, and some risk for laryngeal palsy, most patients surviving the initial stage return to normal life. Because of the greater number of rebleedings than for aneurysms at other locations, immediate treatment is crucial.World Neurosurgery 06/2014; 82(5). DOI:10.1016/j.wneu.2014.06.012 · 2.42 Impact Factor