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Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study

  • Daniele Starnoni
  • Rodolfo MaduriEmail author
  • Khalid Al Taha
  • David Bervini
  • Daniel Walter Zumofen
  • Martin Nikolaus Stienen
  • Bawarjan Schatlo
  • Christian Fung
  • Thomas Robert
  • Martin A. Seule
  • Jan-Karl Burkhardt
  • Nicolai Maldaner
  • Michel Rothlisberger
  • Kristine A. Blackham
  • Serge Marbacher
  • Donato D’Alonzo
  • Luca Remonda
  • Paolo Machi
  • Jan Gralla
  • Philippe Bijlenga
  • Guillaume Saliou
  • Pierluigi Ballabeni
  • Marc Levivier
  • Mahmoud Messerer
  • Swiss SOS Group
  • Roy Thomas Daniel
Original Article - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm

Abstract

Background and purpose

Aneurysms of the posterior inferior cerebellar artery (PICA) are relatively uncommon and evidence is sparse about patients presenting with ruptured PICA aneurysms. We performed an analysis of the Swiss SOS national registry to describe clinical presentation, treatment pattern, and neurological outcome of patients with ruptured PICA aneurysms compared with other ruptured posterior circulation (PC) aneurysms.

Methods

This was a retrospective analysis of anonymized data from the Swiss SOS registry (Swiss Study on Aneurysmal Subarachnoid Hemorrhage; 2009–2014). Patients with ruptured PC aneurysms were subdivided into a PICA and non-PICA group. Clinical, radiological, and treatment-related variables were identified, and their impact on the neurological outcome was determined in terms of modified Rankin score at discharge and at 1 year of follow-up for the two groups.

Results

Data from 1864 aneurysmal subarachnoid hemorrhage patients were reviewed. There were 264 patients with a ruptured PC aneurysm. Seventy-four PICA aneurysms represented 28% of the series; clinical and radiological characteristics at admission were comparable between the PICA and non-PICA group. Surgical treatment was accomplished in 28% of patients in the PICA group and in the 4.8% of patients in the non-PICA group. No statistically significant difference was found between the two groups in terms of complications after treatment. Hydrocephalus requiring definitive shunt was needed in 21.6% of PICA patients (p = 0.6); cranial nerve deficit was present in average a quarter of the patients in both PICA and non-PICA group with no statistical difference (p = 0.3). A more favorable outcome (66.2%) was reported in the PICA group at discharge (p < 0.05) but this difference faded over time with a similar neurological outcome at 1-year follow-up (p = 0.09) between both PICA and non-PICA group. The Kaplan-Meyer estimation showed no significant difference in the mortality rate between both groups (p = 0.08).

Conclusions

In the present study, patients with ruptured PICA aneurysms had a favorable neurological outcome in more than two thirds of cases, similar to patients with other ruptured PC aneurysms. Surgical treatment remains a valid option in a third of cases with ruptured PICA aneurysms.

Keywords

Aneurysmal subarachnoid hemorrhage Posterior circulation Posterior inferior cerebellar artery Intracranial aneurysms Endovascular procedures Intracranial vasospasm Hydrocephalus 

Notes

Acknowledgements

The authors thank all past and present collaborators of the Swiss SOS study group for their support.

Funding

The Department of Clinical Neurosurgery of the Lausanne University Hospital provided financial support in the form of funding for the statistical analysis.

The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the local Ethical Committee (Geneva Ethics Committee Board no. 11-233R, NAC 11-085R) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this retrospective type of study, formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Daniele Starnoni
    • 1
  • Rodolfo Maduri
    • 1
    Email author
  • Khalid Al Taha
    • 1
  • David Bervini
    • 2
  • Daniel Walter Zumofen
    • 3
    • 4
  • Martin Nikolaus Stienen
    • 5
  • Bawarjan Schatlo
    • 6
  • Christian Fung
    • 7
  • Thomas Robert
    • 8
  • Martin A. Seule
    • 9
  • Jan-Karl Burkhardt
    • 5
    • 10
  • Nicolai Maldaner
    • 5
  • Michel Rothlisberger
    • 3
  • Kristine A. Blackham
    • 4
  • Serge Marbacher
    • 11
  • Donato D’Alonzo
    • 11
  • Luca Remonda
    • 12
  • Paolo Machi
    • 13
  • Jan Gralla
    • 14
  • Philippe Bijlenga
    • 15
  • Guillaume Saliou
    • 16
  • Pierluigi Ballabeni
    • 17
    • 18
  • Marc Levivier
    • 1
    • 18
  • Mahmoud Messerer
    • 1
    • 18
  • Swiss SOS Group
  • Roy Thomas Daniel
    • 1
    • 18
  1. 1.Department of Clinical Neurosciences, Service of NeurosurgeryLausanne University Hospital (CHUV)LausanneSwitzerland
  2. 2.Department of Neurosurgery, InselspitalUniversity of BernBernSwitzerland
  3. 3.Department of NeurosurgeryBasel University HospitalBaselSwitzerland
  4. 4.Diagnostic and Interventional Neuroradiology Section, Department of RadiologyBasel University HospitalBaselSwitzerland
  5. 5.Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences CenterUniversity of ZurichZurichSwitzerland
  6. 6.Department of NeurosurgeryUniversity Hospital GöttingenGöttingenGermany
  7. 7.Department of Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
  8. 8.Department of NeurosurgeryOspedale Civico di LuganoLuganoSwitzerland
  9. 9.Department of NeurosurgeryKantonsspital St. GallenSt. GallenSwitzerland
  10. 10.Department of NeurosurgeryBaylor Medical Center and College of MedicineHoustonUSA
  11. 11.Department of NeurosurgeryKantonsspital AarauAarauSwitzerland
  12. 12.Department of Radiology, Division of Diagnostic and Interventional NeuroradiologyKantonsspital AarauAarauSwitzerland
  13. 13.Department of Radiology, Division of Diagnostic and Interventional NeuroradiologyGeneva University Hospital (HUG)GenevaSwitzerland
  14. 14.Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, InselspitalUniversity of BernBernSwitzerland
  15. 15.Department of NeurosurgeryHopitaux Universitaires GenèveGenevaSwitzerland
  16. 16.Department of Radiology, Division of Diagnostic and Interventional NeuroradiologyLausanne University Hospital (CHUV)LausanneSwitzerland
  17. 17.Lausanne Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital Lausanne (CHUV)LausanneSwitzerland
  18. 18.University of Lausanne (UniL)LausanneSwitzerland

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