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

Research output: Contribution to journalArticle

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)549-558
Number of pages10
JournalActa Neurochirurgica
Volume159
Issue number3
DOIs
StatePublished - Mar 1 2017

Keywords

  • Aneurysm
  • Clip occlusion
  • Coil embolization
  • Posterior inferior cerebellar artery
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Sejkorová, A., Petr, O., Mulino, M., Cihlář, J., Hejčl, A., Thomé, C., Sameš, M., & Lanzino, G. (2017). Management of posterior inferior cerebellar artery aneurysms: What factors play the most important role in outcome? Acta Neurochirurgica, 159(3), 549-558. https://doi.org/10.1007/s00701-016-3058-z