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Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis

  • Review Article - Vascular
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Abstract

Introduction

We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms.

Methods

A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality.

Results

We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 % (95 % CI = 94.5–99.0 %) in the surgical group and 84.3 % (95 % CI = 73.8–92.6 %) in the endovascular group. Aneurysm recurrence occurred in 1.4 % (95 % CI = 0.3–3.3 %) after surgery and in 6.9 % (95 % CI = 3.6–10.9 %) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 % (95 % CI = 8.7–21.2 %) and 9.8 % (95 % CI = 5.8–14.8 %) after surgery and 15.1 % (95 % CI = 10.5–20.2 %) and 17.1 % (95 % CI = 11.5–23.7 %) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 % (95 % CI = 79.5–100 %) in the surgical group and 75.7 % (95 % CI = 45.4–97.1 %) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 % (95 % CI = 74.4–100 %) in the surgical series and 93.3 % (95 % CI = 82.7–99.5 %) in the endovascular group.

Conclusions

Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.

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Authors and Affiliations

  1. Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Ondra Petr, Alena Sejkorová & Giuseppe Lanzino

  2. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

    Ondra Petr

  3. Neurosurgery Department, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic

    Alena Sejkorová

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

    Alena Sejkorová

  5. Department of Neurosurgery of 1st Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Prague, Czech Republic

    Ondřej Bradáč

  6. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Waleed Brinjikji

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  1. Ondra Petr
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Correspondence to Ondra Petr.

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Petr, O., Sejkorová, A., Bradáč, O. et al. Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis. Acta Neurochir 158, 2415–2428 (2016). https://doi.org/10.1007/s00701-016-2965-3

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  • DOI: https://doi.org/10.1007/s00701-016-2965-3

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