Acta Neurochirurgica

, Volume 159, Issue 3, pp 549–558

Management of posterior inferior cerebellar artery aneurysms: What factors play the most important role in outcome?

  • Alena Sejkorová
  • Ondra Petr
  • Miriam Mulino
  • Jiří Cihlář
  • Aleš Hejčl
  • Claudius Thomé
  • Martin Sameš
  • Giuseppe Lanzino
Original Article - Vascular
  • 332 Downloads

Abstract

Background

Posterior inferior cerebellar artery (PICA) aneurysms are an uncommon, heterogeneous group of aneurysms with poorer clinical outcomes compared to other intracranial aneurysms. We performed a multicenter retrospective study to analyze the outcome in a large series of patients treated with modern microsurgical and endovascular techniques.

Methods

Records of 94 patients treated for PICA aneurysms between 2000 and 2015 at three large tertiary referral centers were retrospectively reviewed.

Results

Eighty-three patients met inclusion criteria and of these, two died before treatment, leaving 81 treated patients (43 underwent endovascular and 38 surgical treatment). Among patients treated endovascularly, procedure-related complications occurred in four cases (11.8%). Six patients (19.4%) suffered from complications directly associated with surgery. Recurrences occurred in 0% of surgical and in 16.3% of endovascularly treated patients, requiring treatment. Patients with unruptured asymptomatic aneurysms had good outcomes. In the group of 67 ruptured aneurysms, 16 endovascularly (47.1%) and 15 surgically (48.4%) treated patients had modified Rankin scale (mRS) scores of 3–6. Of patients in poor neurological condition (Hunt & Hess (H&H) IV–V at admission), 84.6% suffered a poor clinical outcome. Fifty percent of patients with distal and 31.9% patients with proximal ruptured PICA aneurysms suffered a poor neurological outcome.

Conclusions

This study of PICA aneurysms demonstrates that results of both treatment modalities are comparable. However, endovascular treatment is associated with higher risks of recurrence, requiring additional treatment. Outcomes were mostly impacted by clinical state at admission.

Keywords

Aneurysm Clip occlusion Coil embolization Posterior inferior cerebellar artery Subarachnoid hemorrhage 

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Alena Sejkorová
    • 1
    • 2
  • Ondra Petr
    • 3
  • Miriam Mulino
    • 3
  • Jiří Cihlář
    • 4
  • Aleš Hejčl
    • 1
    • 5
  • Claudius Thomé
    • 3
  • Martin Sameš
    • 1
  • Giuseppe Lanzino
    • 2
  1. 1.Neurosurgery DepartmentJ.E. Purkynje University, Masaryk HospitalÚstí nad LabemCzech Republic
  2. 2.Department of Neurological SurgeryMayo ClinicRochesterUSA
  3. 3.Department of NeurosurgeryMedical University InnsbruckInnsbruckAustria
  4. 4.Department of Mathematics, Faculty of ScienceJ.E. Purkynje UniversityÚsti nad LabemCzech Republic
  5. 5.International Clinical Research CenterSt. Anne’s University HospitalBrnoCzech Republic

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