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Isolated dissections and dissecting aneurysms of the posterior inferior cerebellar artery: topic and literature review

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Abstract

Isolated dissections of the posterior inferior cerebellar artery (PICA) are rare. Thus, no large series of cases have been reported in the literature. Due to limited knowledge regarding the natural history of these lesions and the lack of high-quality evidence supporting various treatment options, management is controversial and practice parameters are ill defined. In order to offer a comprehensive reference for the diagnosis and management of isolated PICA dissections, the authors reviewed the National Library of Medicine from 1966 to October 2001. Twenty-seven patients averaging 43.6 years of age and including 14 males and 13 females were reported. Subarachnoid hemorrhage occurred in 20 patients, and two died. Dissections were located in the proximal PICA in 22 patients and were three times more common on the left side (left:right=3:1). Six patients were managed conservatively, and four with endovascular techniques. Seventeen had open surgery: five underwent resection, two went through trapping, and two had proximal clipping. Wrapping with muscle was performed in two patients, encasement with Sundt clips in two, and four had occipital artery (OA)-PICA bypass surgery. A meticulous analysis of reported cases with regard to clinical and pathological features, management strategies, and outcomes is presented.

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References

  1. Amarenco P, Roullet E, Hommel M, Chaine P, Marteau R (1990) Infarction in the territory of the medial branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 53:731–735

  2. Ausman JI, Diaz FG, Mullan S, Gehring R, Sadasivan B, Dujovny M (1990) Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73:462–465

  3. Berger MS, Wilson CB (1984) Intracranial dissecting aneurysms of the posterior circulation. J Neurosurg 61:882–894

  4. Berkovic SF, Spokes RL, Anderson RM, Bladin PF (1983) Basilar artery dissection. J Neurol Neurosurg Psychiatry 46:126–129

  5. Beyerl BD, Heros RC (1986) Multiple peripheral aneurysms of the posterior inferior cerebellar artery. Neurosurgery 19:285–289

  6. Carter LP, Spetzler RF (1994) Neurovascular surgery. McGraw-Hill, New York, pp 642–643

  7. Dinichert A, Rufenacht DA, De Tribolet N (2000) Dissecting aneurysms of the posterior inferior cerebellar artery: report of four cases and review of the literature. J Clin Neurosci 7:515–520

  8. Dolenc V (1982) End-to-end suture of the posterior inferior cerebellar artery after the excision of a large aneurysm: case report. Neurosurgery 11:690–693

  9. Durward QJ (1995) Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82:137–139

  10. Farrell MA, Gilbert JJ, Kaufmann JC (1985) Fatal intracranial arterial dissection: clinical pathological correlation. J Neurol Neurosurg Psychiatry 48:111–121

  11. Feely MP (1979) Cerebellar infarction. Neurosurgery 4:7–11

  12. Forbus WD (1929) Über den Ursprung gewisser Aneurysmen der basalen Hirnarterien. Zentralbl Allg Pathol Anat 44:243–245

  13. Fransen P, De Tribolet N (1994) Dissecting aneurysms of the posterior inferior cerebellar artery. Br J Neurosurg 8:381–386

  14. Friedman AH, Drake CG (1984) Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334

  15. Halbach VV, Higashida RT, Dowd CF, Fraser KW, Smith TP, Teitelbaum GP, Wilson CB, Hieshima GB (1993) Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:183–191

  16. Hamada J, Nagahiro S, Mimata C, Kaku T, Ushio Y (1996) Reconstruction of the posterior inferior cerebellar artery in the treatment of giant aneurysms. Report of two cases. J Neurosurg 85:496–499

  17. Hashimoto T, Kanki T, Abe S, Nakazawa K, Nakamura N (1992) Dissecting aneurysm of the vertebro-basilar system: surgical treatment in cases with brainstem ischemia. Jpn J Stroke 14:355–360

  18. 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

  19. Hunter J (1837) An account of Mr. Hunter's method of performing the operation for the cure of the popliteal aneurism. In: Palmer JF (ed) The works of John Hunter, vol 3. Longman, Rees, Orme, Brown, Green, and Longman, London, pp 594–612

  20. Ikeda A, Yamaguchi T, Yamaguchi T, Yamamoto I, Sato O (1991) Excision and end-to-end anastomosis of a fusiform aneurysm of the distal posterior inferior cerebellar artery associated with ischemia. Neurol Med Chir (Tokyo) 31:351–355

  21. Iwama T, Andoh T, Sakai N, Iwata T, Hirata T, Yamada H (1990) Dissecting and fusiform aneurysms of vertebro-basilar systems. MR imaging. Neuroradiology 32:272–279

  22. Jafar JJ, Kamiryo T, Chiles BW, Nelson PK (1998) A dissecting aneurysm of the posteroinferior cerebellar artery. Neurosurgery 43:353–356

  23. Kamiyama H, Nomura M, Abe H, Abumiya T, Saito H, Yamauchi T, Mitsumori K, Yoshimoto T, Takigawa S, Ito T, Houkin K, Isu T, Kawamoto S, Ishikawa T, Yasui N (1990) Diagnosis for the intracranial dissecting aneurysms. Surg Cereb Stroke 19:50–56

  24. Kanou Y, Arita K, Kurisu K, Ikawa F, Eguchi K, Monden S, Watanabe K (2000) Dissecting aneurysm of the peripheral posterior inferior cerebellar artery. Acta Neurochir (Wien) 142:1151–1156

  25. Kawaguchi S, Sakaki T, Kamada K, Iwanaga H, Takehashi K, Tsujimoto M (1993) Dissecting aneurysm of the posterior inferior cerebellar artery – case report. Neurol Med Chir (Tokyo) 33:634–637

  26. Kawaguchi S, Sakaki T, Tsunoda S, Morimoto T, Hoshida T, Kawai S, Iwanaga H, Nikaido Y (1994) Management of dissecting aneurysms of the posterior circulation. Acta Neurochir (Wien) 131:26–31

  27. Kitanaka C, Morimoto T, Sasaki T, Takakura K (1992) Rebleeding from vertebral artery dissection after proximal clipping. Case report. J Neurosurg 77:466–468

  28. Kitanaka C, Sasaki T, Eguchi T, Teraoka A, Nakane M, Hoya K (1994) Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627

  29. Kitanaka C, Tanaka J, Kuwahara M, Teraoka A, Sasaki T, Takakura K (1994) Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80:667–674

  30. Komiya H, Saeki N, Iwadate Y, Sunami K, Yamaura A (1988) Posterior inferior cerebellar artery dissecting aneurysm presenting with Wallenberg's syndrome. Neurol Med Chir (Tokyo) 28:404–408

  31. Kopera M, Majchrzak H, Ladzinski P, Stech W, Maliszewski M (1992) Dissecting aneurysm of the posterior inferior cerebellar artery. Neurol Neurochir Pol 26:897–901

  32. Lee SY, Sekhar LN (1996) Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting. Report of three cases. J Neurosurg 85:178–185

  33. Lefkowitz MA, Teitelbaum GP, Giannotta SL (1996) Endovascular treatment of a dissecting posteroinferior cerebellar artery aneurysm: case report. Neurosurgery 39:1036–1039

  34. Lister JR, Rhoton AL Jr, Matsushima T, Peace DA (1982) Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery 10:170–199

  35. Madsen JR, Heros RC (1988) Giant peripheral aneurysm of the posterior inferior cerebellar artery treated with excision and end-to-end anastomosis. Surg Neurol 30:140–143

  36. Mizushima H, Sasaki K, Kunii N, Nishino T, Jinbo H, Abe T, Shimazu M, Matsumoto K (1994) Dissecting aneurysm in the proximal region of the posterior inferior cerebellar artery presenting as Wallenberg's syndrome. Neurol Med Chir (Tokyo) 34:307–310

  37. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–913

  38. Nagahiro S, Goto S, Yoshioka S, Ushio Y (1993) Dissecting aneurysm of the posterior inferior cerebellar artery: case report. Neurosurgery 33:739–742

  39. Nakagawa K, Touho H, Morisako T, Osaka Y, Tatsuzawa K, Nakae H, Owada K, Matsuda K, Karasawa J (2000) Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings. J Neurosurg 93:19–25

  40. Nakatomi H, Nagata K, Kawamoto S (1999) Persistent patent pseudolumen of ruptured dissecting aneurysm involving the posterior inferior cerebellar artery after proximal clipping. Acta Neurochir (Wien) 141:533–536

  41. Nishino A, Sakurai Y, Niizuma H, Satoh H, Kayama T (1991) Dissecting aneurysm of distal posterior inferior cerebellar artery. No To Shinkei 43:381–386

  42. Piske RL, Darwich R, Campos CMS, Fonseca NC, Oliveira E, Souza A (1998) Spontaneous resolution of a ruptured dissecting PICA aneurysm. Intervent Neurorad 4:287–292

  43. Pozzati E, Padovani R, Fabrizi A, Sabattini L, Gaist G (1991) Benign arterial dissections of the posterior circulation. J Neurosurg 75:69–72

  44. Price DB, Miller LJ (1994) MR angiography of peripheral posterior inferior cerebellar artery aneurysms. J Comput Assist Tomogr 18:539–541

  45. Quint DJ, Spickler EM (1990) Magnetic resonance demonstration of vertebral artery dissection. Report of two cases. J Neurosurg 72:964–967

  46. Renfro MB, Day AL, Rhoton AL (1997) The extracranial and intracranial vessels: normal anatomy and variations. In: Batjer HH (ed) Cerebrovascular disease. Lippincott-Raven, Philadelphia, pp 3–22

  47. Saito A, Ezura M, Takahashi A, Yoshimoto T (2000) An arterial dissection of the distal anterior inferior cerebellar artery treated by endovascular therapy. No Shinkei Geka 28:269–274

  48. Sekino H, Nakamura N, Kato Y, Basugi N (1981) Dissecting aneurysms of the vertebro-basilar system: clinical and angiographic observations. No Shinkei Geka 9:125–133

  49. Shinoda S, Murata H, Waga S, Kojima T (1998) Bilateral spontaneous dissection of the posteroinferior cerebellar arteries: case report. Neurosurgery 43:357–359

  50. Stehbens WE (1996) The pathogenesis of intracranial aneurysms. In: Tindall GT, Cooper PRI, Barrow DL (eds) The practice of neurosurgery. Williams and Wilkins, Baltimore, pp 1941–1952

  51. Suzukawa K, Amoh M, Nakamura Y, Yasuma Y, Kurokawa S (2000) Spontaneous occlusion of a dissecting aneurysm in the shape of "two dumplings on a skewer" at right posterior inferior cerebellar artery (PICA): report of a case and neuroradiological findings. No Shinkei Geka 28:561–567

  52. Takahashi I, Takamura H, Gotoh S, Sasaki H, Makino K, Suzuki N, Nishihara I, Ishikawa T, Andoh M (1992) Dissecting aneurysm of the posterior inferior cerebellar artery. No Shinkei Geka 20:277–281

  53. Takikawa S, Kamiyama H, Nomura M, Abe H, Saitoh H (1991) Vertebral dissecting aneurysm treated with trapping and bilateral posterior inferior cerebellar artery side-to side anastomosis: case report. No Shinkei Geka 19:571–576

  54. Tamano Y, Ujiie H, Hori T (2000) Postoperative hemorrhage due to normal pressure hyperperfusion breakthrough after a trapping of VA-PICA dissecting aneurysm. No Shinkei Geka 28:257–262

  55. Teitelbaum GP, Dowd CF, Larsen DW, McDougall CG, Halbach VV, Higashida RT, Hieshima GB (1995) Endovascular management of biopsy-related posterior inferior cerebellar artery pseudoaneurysm. Surg Neurol 43:357–359

  56. Tikkakoski T, Leinonen S, Siniluoto T, Koivukangas J (1997) Isolated dissecting aneurysm of the left posterior inferior cerebellar artery: endovascular treatment with a Guglielmi detachable coil. AJNR Am J Neuroradiol 18:936–938

  57. Ueki K, Teraoka A, Yoshida S, Hori T (1987) Dissecting aneurysm of the posterior inferior cerebellar artery – a case report. No Shinkei Geka 15:1215–1219

  58. Victor M, Ropper AH, Adams RD (2001) Cerebrovascular diseases. In: Victor M, Ropper AH (eds) Adams and Victor's Principles of Neurology, 7th edn. McGraw-Hill, New York, pp 821–924

  59. Yamaura A, Isobe K, Karasudani H, Tanaka M, Komiya H (1991) Dissecting aneurysms of the posterior inferior cerebellar artery. Neurosurgery 28:894–898

  60. Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188

  61. Yamaura A (1988) Diagnosis and treatment of vertebral aneurysms. J Neurosurg 69:345–349

  62. Yamaura I, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, Matsumoto T (1999) Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90:853–856

  63. Yasui T, Komiyama M, Nishikawa M, Nakajima H (2000) Subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature. Neurosurgery 46:196–201

  64. Yonas H, Agamanolis D, Takaoka Y, White RJ (1977) Dissecting intracranial aneurysms. Surg Neurol 8:407–415

  65. Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28:370–374

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Authors and Affiliations

  1. Department of Neurosurgery, Northwestern University Medical School, 233 E. Erie Street, Suite 614, Chicago, IL 60611, Chicago, IL, USA

    Rabih G. Tawk, Bernard R. Bendok, Christopher C. Getch, Jayashree Srinivasan & H. Hunt Batjer

  2. Department of Neurology, State University of New York at Buffalo Medical School, Buffalo, N.Y., Buffalo, N.Y., USA

    Adnan I. Qureshi

  3. Department of Neurology, Northwestern University Medical School, Chicago, Ill., Chicago, Ill., USA

    Mark Alberts

  4. Department of Radiology, Northwestern University Medical School, Chicago, Ill., Chicago, Ill., USA

    Eric J. Russell

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  1. Rabih G. Tawk
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Correspondence to H. Hunt Batjer.

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Tawk, R.G., Bendok, B.R., Qureshi, A.I. et al. Isolated dissections and dissecting aneurysms of the posterior inferior cerebellar artery: topic and literature review. Neurosurg Rev 26, 180–187 (2003). https://doi.org/10.1007/s10143-002-0231-z

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