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Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms

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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.

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References

  1. Al-khayat H, Beshay J, Manner D, White J (2005) Vertebral artery-posteroinferior cerebellar artery aneurysms: clinical and lower cranial nerve outcomes in 52 patients. Neurosurgery 56:2–10, discussion 11

    Article  PubMed  Google Scholar 

  2. Bacigaluppi S, Bergui M, Crobeddu E, Garbossa D, Ducati A, Fontanella M (2013) Aneurysms of the medullary segments of the posterior-inferior cerebellar artery: considerations on treatment strategy and clinical outcome. Neurol Sci 34:529–536

    Article  PubMed  Google Scholar 

  3. Bertalanffy H, Sure U, Petermeyer M et al (1998) Management of aneurysms of the vertebral artery-posterior inferior cerebellar artery complex. Neurol Med Chir 38(Suppl):93–103

    Article  Google Scholar 

  4. Bertalanffy H, Benes L, Heinze S, Tirakotai W, Sure U (2006) Surgical management of aneurysms of the vertebral and posterior inferior cerebellar artery complex. In: Schmidek HH, Roberts DW (eds) Schmidek and Sweet’s operative neurosurgical techniques, indications, methods, and results, 5th edn. Saunders Elsevier, Philadelphia, pp 1209–1223

    Google Scholar 

  5. Bohnstedt BN, Ziemba-Davis M, Edwards G, Brom J, Payner TD, Leipzig TJ, Scott JA et al (2015) Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation. World Neurosurg. doi:10.1016/j.wneu.2014.12.035, 2014 Dec 23 [Epub ahead of print]

    PubMed  Google Scholar 

  6. Bradac GB, Bergui M (2004) Endovascular treatment of the posterior inferior cerebellar artery aneurysms. Neuroradiology 46:1006–1011

    Article  PubMed  CAS  Google Scholar 

  7. Chalouhi N, Jabbour P, Starke RM, Tjoumakaris SI, Gonzalez LF, Witte S, Rosenwasser RH (2013) Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms. J Neurosurg 118:991–99

    Article  PubMed  Google Scholar 

  8. Crowley RW, Albuquerque FC, Ducruet AF, Williamson RW, McDougall CG (2012) Technical considerations in the endovascular management of aneurysms of the posterior inferior cerebellar artery. Neurosurgery 71:ons204–ons218

    PubMed  Google Scholar 

  9. Fujimura M, Nishijima M, Midorikawa H, Umezawa K, Hayashi T, Kaimori M (2003) Fatal rupture following intra-aneurysmal embolization for the distal posterior inferior cerebellar artery aneurysms with parent artery preservation. Clin Neurol Neurosurg 105:117–120

    Article  PubMed  Google Scholar 

  10. Horiuchi T, Tanaka Y, Hongo K, Nitta J, Kusano Y, Kobayashi S (2003) Characteristics of distal posteroinferior cerebellar artery aneurysms. Neurosurgery 53:589–596

    Article  PubMed  Google Scholar 

  11. Hudgins RJ, Day AL, Quisling RG, Rhoton AL Jr, Sypert GW, Garcia-Bengochea F (1983) Aneurysms of the posterior inferior cerebellar artery. A clinical and anatomical analysis. J Neurosurg 58:381–387

    Article  PubMed  CAS  Google Scholar 

  12. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20

    Article  PubMed  CAS  Google Scholar 

  13. Ioannidis I, Nasis N, Andreou A (2012) Endovascular treatment of ruptured dissecting posterior inferior cerebellar artery aneurysms. Interv Neuroradiol 18:442–448

    PubMed  CAS  PubMed Central  Google Scholar 

  14. Ishikawa T, Suzuki A, Yasui N (1990) Distal posterior inferior cerebellar aneurysms—report of 12 cases. Neurol Med Chir (Tokyo) 30:100–108

    Article  CAS  Google Scholar 

  15. Kallmes DF, Lanzino G, Dix JE, Din JE, Do H, Woodcock RJ, Kassell NF (1997) Patterns of hemorrhage with ruptured posterior inferior cerebellar artery aneurysms: CT findings in 44 cases. AJR Am J Roentgenol 69:1169–1171

    Article  Google Scholar 

  16. Kaptain GJ, Lanzino G, Do HM, Kassell NF (1999) Posterior inferior cerebellar artery aneurysms associated with posterior fossa arteriovenous malformation: report of five cases and literature review. Surg Neurol 51:146–152

    Article  PubMed  CAS  Google Scholar 

  17. Kashiwagi S, Tsuchida E, Shiroyqma Y et al (1992) Paraplegia due to ruptured aneurysms of the distal posterior inferior cerebellar artery. J Neurol neurosurg Psychiatry 55:836–837

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Kawashima M, Jr RA, Tanriover N, Ulm AJ, Yasuda A, Fujii K (2005) Microsurgical anatomy of cerebral revascularization. Part II: posterior circulation. J Neurosurg 102:132–147

    Article  PubMed  Google Scholar 

  19. Lanzino G, Paolini S, Spetzler RF (2005) Far-lateral approach to the craniocervical junction. Neurosurg 57:367–371

    Article  Google Scholar 

  20. Lehto H, Harati A, Niemelä M, Dashti R, Laakso A, Elsharkawy A, Satopää J et al (2014) Distal posterior inferior cerebellar artery aneurysms: clinical features and outcome of 80 patients. World Neurosurg 82(5):702–713

    Article  PubMed  Google Scholar 

  21. Lewis SB, Chang DJ, Peace DA, Lafrentz PJ, Day AL (2002) Distal posterior inferior cerebellar artery aneurysms: clinical features and management. J Neurolosurg 97:756–766

    Article  Google Scholar 

  22. Li XE, Wang YY, Li G, Jia DZ, Liu XH, Gao J, Li XG (2008) Clinical presentation and treatment of distal posterior inferior cerebellar artery aneurysms: report of five cases. Surg Nerol 70:425430

    Google Scholar 

  23. Lister JR, Rhoton AL Jr, Matsushima T, Peace DA (2003) Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery 10:170–199

    Article  Google Scholar 

  24. Molyneux A, Kerr R (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  25. Novák P, Drábek P, Paleček T (1999) Distální aneurysma na a. cerebelli inferior posterior. Čes. a slov. Neurol Neurochir 62/95, NO. 6:345–348

    Google Scholar 

  26. Nussbaum ES, Madison MT, Goddard JK, Lassig JP, Nussbaum LA (2009) Peripheral intracranial aneurysms: management challenges in 60 consecutive cases. J Neurosurg 110:7–13

    Article  PubMed  Google Scholar 

  27. Nussbaum ES, Madison MT, Myers ME, Goddard J, Janjua T (2008) Dissecting aneurysms of the posterior inferior cerebellar artery: retrospective evaluation of management and extended follow-up review in 6 patients. J Neurosurg 109:23–27

    Article  PubMed  Google Scholar 

  28. Orakcioglu B, Schuknecht B, Otani N, Khan N, Imhof HG, Yonekawa Y (2005) Distal posterior inferior cerebellar artery aneurysms: clinical characteristics and surgical management. Acta Neurochir 147:1131–1139

    Article  PubMed  CAS  Google Scholar 

  29. Peerless SJ, Hernesniemi JA, Gutman FB, Drake CG (1994) Early surgery for ruptured vertebrobasilar aneurysms. J Neurosurg 80:643–649

    Article  PubMed  CAS  Google Scholar 

  30. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB (2008) Posterior inferior cerebellar artery aneurysms: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol 29:86–90

    Article  PubMed  CAS  Google Scholar 

  31. Rohde V, Schaller C, Hassler W (1994) The extreme lateral transcondylar approach to aneurysms of the vertebrobasilar junction, the vertebral artery, and the posterior inferior cerebellar artery. Skull Base Surgery 4:177–180

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  32. Tanaka A, Kimura M, Yoshinaga S et al (1993) Extracranial aneurysm of the posterior inferior cerebellar artery: case report. Neurosurgery 33:742–745

    Article  PubMed  CAS  Google Scholar 

  33. Tokimura H, Yamahata H, Kamezawa T et al (2011) Clinical presentation and treatment of distal posterior inferior cerebellar artery aneurysms. Neurosurg Rev 34:57–67

    Article  PubMed  Google Scholar 

  34. Trivelato FP, Salles Rezende MT, Castro GD, Manzato LB, Santoro Araújo JF, Ulhôa AC (2014) Endovascular treatment of isolated posterior inferior cerebellar artery dissecting aneurysms: parent artery occlusion or selective coiling? Clin Neuroradiol 24(3):255–61

    Article  PubMed  CAS  Google Scholar 

  35. Viswanathan GC, Menon G, Nair S, Abraham M (2014) Posterior inferior cerebellar artery aneurysms: operative strategies based on a surgical series of 27 patients. Turkish Neurosurgery 24(1):30–37

    PubMed  Google Scholar 

  36. Williamson RW, Wilson DA, Abla AA, McDougall CG, Nakaji P, Albuquerque FC, Spetzler RF (2015) Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: a comparative analysis. J Neurosurg 2015 Apr 17:1–5 [Epub ahead of print]

    Google Scholar 

Download references

Acknowledgments

This study is supported by the European Regional Development Fund-Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123).

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Neurosurgery Department, J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, Ústí nad Labem, 401 13, Czech Republic

    A. Sejkorová, A. Hejčl, P. Vachata & Martin Sameš

  2. Radiology Department, Masaryk Hospital, Ústí nad Labem, Czech Republic

    F. Cihlář

  3. International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic

    A. Sejkorová, A. Hejčl & P. Vachata

  4. 2nd Faculty of Medicine, Charles University, Prague, Czech Republic

    J. Lodin

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  1. A. Sejkorová
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  2. F. Cihlář
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  3. A. Hejčl
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  4. J. Lodin
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  5. P. Vachata
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Correspondence to Martin Sameš.

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Comments

Waleed A. Azab, New York, USA

The authors present a well-written and thoughtful manuscript in which they elaborate on management strategies for PICA aneurysms. There exists a paucity of the current literature on such a topic with many unsolved areas of controversy. Their series represents a local experience with relatively large number of cases and sheds the light on a multitude of aspects pertaining to the subject. I think that their work is a valuable addition to our neurosurgical literature.

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Sejkorová, A., Cihlář, F., Hejčl, A. et al. Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms. Neurosurg Rev 39, 159–168 (2016). https://doi.org/10.1007/s10143-015-0659-6

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  • DOI: https://doi.org/10.1007/s10143-015-0659-6

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