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.
Similar content being viewed by others
Change history
17 May 2019
Incorrect authorgroup and authorname.
References
Ali MJ, Bendok BR, Tawk RG, Getch CC, Batjer HH (2002) Trapping and revascularization for a dissecting aneurysm of the proximal posteroinferior cerebellar artery: technical case report and review of the literature. Neurosurgery 51:258–262 discussion 262-253
Awad AJ, Mascitelli JR, Haroun RR, De Leacy RA, Fifi JT, Mocco J (2017) Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion. Neurosurg Focus 42:E14. https://doi.org/10.3171/2017.3.FOCUS1748
Bohnstedt BN, Ziemba-Davis M, Edwards G, Brom J, Payner TD, Leipzig TJ, Scott JA, DeNardo AJ, Palmer E, Cohen-Gadol AA (2015) Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation. World Neurosurg 83:784–793. https://doi.org/10.1016/j.wneu.2014.12.035
Burkhardt JK, Neidert MC, Stienen MN, Schoni D, Fung C, Roethlisberger M, Corniola MV, Bervini D, Maduri R, Valsecchi D, Tok S, Schatlo B, Bijlenga P, Schaller K, Bozinov O, Regli L, SOSsg S (2017) Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage. Acta Neurochir 159:1305–1312. https://doi.org/10.1007/s00701-016-3072-1
Chalouhi N, Jabbour P, Starke RM, Tjoumakaris SI, Gonzalez LF, Witte S, Rosenwasser RH, Dumont AS (2013) Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms. J Neurosurg 118:991–999. https://doi.org/10.3171/2012.12.JNS121240
Coert BA, Chang SD, Do HM, Marks MP, Steinberg GK (2007) Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms. J Neurosurg 106:855–865. https://doi.org/10.3171/jns.2007.106.5.855
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–ons217; discussion ons217-208. https://doi.org/10.1227/NEU.0b013e31826920b4
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9
Horiuchi T, Tanaka Y, Hongo K, Nitta J, Kusano Y, Kobayashi S (2003) Characteristics of distal posteroinferior cerebellar artery aneurysms. Neurosurgery 53:589–595; discussion 595-586
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. https://doi.org/10.3171/jns.1983.58.3.0381
Kalani MY, Zabramski JM, Nakaji P, Spetzler RF (2013) Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms. Neurosurgery 72:763–775; discussion 775-766. https://doi.org/10.1227/NEU.0b013e3182870703
Kallmes DF, Lanzino G, Dix JE, Dion 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 169:1169–1171. https://doi.org/10.2214/ajr.169.4.9308484
Lawton MT, Abla AA, Rutledge WC, Benet A, Zador Z, Rayz VL, Saloner D, Halbach VV (2016) Bypass surgery for the treatment of Dolichoectatic basilar trunk aneurysms: a work in Progress. Neurosurgery 79:83–99. https://doi.org/10.1227/NEU.0000000000001175
Lehto H, Harati A, Niemela M, Dashti R, Laakso A, Elsharkawy A, Satopaa J, Billon-Grand R, Canato B, Kivisaari R, Hernesniemi J (2014) Distal posterior inferior cerebellar artery aneurysms: clinical features and outcome of 80 patients. World Neurosurg 82:702–713. https://doi.org/10.1016/j.wneu.2014.06.012
Mericle RA, Reig AS, Burry MV, Eskioglu E, Firment CS, Santra S (2006) Endovascular surgery for proximal posterior inferior cerebellar artery aneurysms: an analysis of Glasgow outcome score by hunt-Hess grades. Neurosurgery 58:619–625; discussion 619-625. https://doi.org/10.1227/01.NEU.0000204127.81249.28
Neidert MC, Maldaner N, Stienen MN, Roethlisberger M, Zumofen DW, D'Alonzo D, Marbacher S, Maduri R, Hostettler IC, Schatlo B, Schneider MM, Seule MA, Schoni D, Goldberg J, Fung C, Arrighi M, Valsecchi D, Bijlenga P, Schaller K, Bozinov O, Regli L, Burkhardt JK, SOSsg S (2018) The Barrow neurological institute grading scale as a predictor for delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage: data from a Nationwide patient registry (Swiss SOS). Neurosurgery 83:1286–1293. https://doi.org/10.1093/neuros/nyx609
No Authors (1988) Report of world Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 68:985–986
Nussbaum ES, Mendez A, Camarata P, Sebring L (2003) Surgical management of fusiform aneurysms of the peripheral posteroinferior cerebellar artery. Neurosurgery 53:831–834; discussion 834-835
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. https://doi.org/10.3174/ajnr.A0758
Rodriguez-Hernandez A, Lawton MT (2011) Anatomical triangles defining surgical routes to posterior inferior cerebellar artery aneurysms. J Neurosurg 114:1088–1094. https://doi.org/10.3171/2010.8.JNS10759
Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D'Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schoni D, Goldberg J, Valsecchi D, Robert T, Maduri R, Seule MA, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Zumofen DW, SOSg S (2018) Impact of aneurysm multiplicity on treatment and outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. https://doi.org/10.1093/neuros/nyy331
Sanai N, Tarapore P, Lee AC, Lawton MT (2008) The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era. Neurosurgery 62:1236–1249; discussion 1249-1253. https://doi.org/10.1227/01.neu.0000333295.59738.de
Schatlo B, Fung C, Fathi AR, Sailer M, Winkler K, Daniel RT, Bijlenga P, Ahlborn P, Seule M, Zumofen D, Reinert M, Woernle C, Stienen M, Levivier M, Hildebrandt G, Mariani L, Bernays R, Fandino J, Raabe A, Keller E, Schaller K (2012) Introducing a nationwide registry: the Swiss study on aneurysmal subarachnoid haemorrhage (Swiss SOS). Acta Neurochir 154:2173–2178; discussion 2178. https://doi.org/10.1007/s00701-012-1500-4
Sejkorova A, Petr O, Mulino M, Cihlar J, Hejcl A, Thome C, Sames M, Lanzino G (2017) Management of posterior inferior cerebellar artery aneurysms: what factors play the most important role in outcome? Acta Neurochir 159:549–558. https://doi.org/10.1007/s00701-016-3058-z
Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Russin JJ, Partovi S, Nakaji P, Wallace RC (2015) The Barrow ruptured aneurysm trial: 6-year results. J Neurosurg 123:609–617. https://doi.org/10.3171/2014.9.JNS141749
Stienen MN, Germans M, Burkhardt JK, Neidert MC, Fung C, Bervini D, Zumofen D, Rothlisberger M, Marbacher S, Maduri R, Robert T, Seule MA, Bijlenga P, Schaller K, Fandino J, Smoll NR, Maldaner N, Finkenstadt S, Esposito G, Schatlo B, Keller E, Bozinov O, Regli L, Swiss SOSSG (2018) Predictors of in-hospital death after aneurysmal subarachnoid hemorrhage: analysis of a Nationwide database (Swiss SOS [Swiss study on aneurysmal subarachnoid hemorrhage]). Stroke 49:333–340. https://doi.org/10.1161/STROKEAHA.117.019328
Tokimura H, Yamahata H, Kamezawa T, Tajitsu K, Nagayama T, Sugata S, Takiguchi K, Taniguchi A, Niiro M, Hirahara K, Takasaki K, Oyoshi T, Arita K (2011) Clinical presentation and treatment of distal posterior inferior cerebellar artery aneurysms. Neurosurg Rev 34:57–67. https://doi.org/10.1007/s10143-010-0296-z
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607
Vergouwen MD, Jong-Tjien-Fa AV, Algra A, Rinkel GJ (2016) Time trends in causes of death after aneurysmal subarachnoid hemorrhage: a hospital-based study. Neurology 86:59–63. https://doi.org/10.1212/WNL.0000000000002239
Vergouwen MD, Vermeulen M, van Gijn J, Rinkel GJ, Wijdicks EF, Muizelaar JP, Mendelow AD, Juvela S, Yonas H, Terbrugge KG, Macdonald RL, Diringer MN, Broderick JP, Dreier JP, Roos YB (2010) Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 41:2391–2395. https://doi.org/10.1161/STROKEAHA.110.589275
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 123:441–445. https://doi.org/10.3171/2014.10.JNS141079
Zumofen DW, Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D'Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schoeni D, Goldberg J, Valsecchi D, Robert T, Maduri R, Seule M, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Swiss SOSSG (2018) Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage. Neurosurg Rev 41:1059–1069. https://doi.org/10.1007/s10143-018-0952-2
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.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
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.
Additional information
Previous presentations
The results of this study were presented partially at the European Association of Neurosurgical Societies (EANS) in Athens on September 4th 2016.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Vascular Neurosurgery – Aneurysm
Appendix: List of contributors to the Swiss SOS study group
Appendix: List of contributors to the Swiss SOS study group
-
Department of Clinical Neurosciences, Service of Neurosurgery, University Hospital of Lausanne, University of Lausanne, Switzerland.
-
Alda Rocca, MD
-
-
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
-
Bruno Bartolini, MD
-
Steven Hajdu, MD
-
Francesco Puccinelli, MD
-
-
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Zurich University Hospital, University of Zurich, Zurich, Switzerland.
-
Kulcsàr Zsolt, MD
-
-
Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences Center, University of Zurich, Switzerland.
-
Emanuela Keller, MD
-
Luca Regli, MD
-
Oliver Bozinov, MD
-
Sina Finkenstädt, MD
-
-
Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
-
Daniel Schöni, MD
-
Andreas Raabe, MD
-
Jürgen Beck, MD
-
Johannes Goldberg, MD
-
-
Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
-
Luigi Mariani, MD
-
Raphael Guzman, MD
-
-
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
-
Javier Fandino, MD
-
Daniel Coluccia, MD
-
-
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Ospedale Civico di Lugano, Lugano, Switzerland
-
Alessandro Cianfoni, MD
-
-
Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
-
Daniele Valsecchi, MD
-
Alessio Chiappini, MD
-
Alice Venier, MD
-
Michael Reinert, MD
-
-
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
-
Johannes Weber, MD
-
-
Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
-
Andrea Ferrari, MD
-
Astrid Weyerbrock, MD
-
Gerhard Hildebrandt, MD
-
Martin Hlavica, MD
-
-
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Hopitaux Universitaires Genève, Geneva, Switzerland.
-
Vitor Mendes Pereira, MD
-
-
Department of Neurosurgery, Hopitaux Universitaires de Genève, Geneva, Switzerland
-
Marco Corniola, MD
-
Karl Schaller, MD
-
Rights and permissions
About this article
Cite this article
Starnoni, D., Maduri, R., Al Taha, K. et al. Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study. Acta Neurochir 161, 1325–1334 (2019). https://doi.org/10.1007/s00701-019-03894-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-019-03894-5