Dissecting aneurysms of the posterior inferior cerebellar artery: retrospective evaluation of management and extended follow-up review in 6 patients.

Abstract

OBJECT:

The authors report the management protocol and successful outcomes in 6 patients with dissecting aneurysms of the posterior inferior cerebellar artery (PICA).

METHODS:

Medical records and neuroimaging studies of 6 patients who underwent surgical treatment of dissecting PICA aneurysms were reviewed. The mean follow-up duration was 1.8 years. No patient was lost to follow-up review.

RESULTS:

Four patients presented with acute subarachnoid hemorrhage and 2 with PICA ischemia. All patients underwent surgery, which entailed proximal occlusion with distal revascularization in 3 cases and circumferential wrap/clip reconstruction in 3 cases. The revascularization techniques used were occipital artery-PICA bypass and PICA-PICA anastomosis. Delayed follow-up angiography was performed in all cases. In patients treated with proximal occlusion, delayed angiography showed minimal retrograde opacification of the dissected segments. The 3 patients treated with wrap/clip reconstruction showed unexpectedly significant normalization of their lesions on angiographic studies. Outcome was good in all cases.

CONCLUSIONS:

Dissecting PICA aneurysms are rare lesions with an apparent propensity for bleeding. Individualized management including distal revascularization with PICA sacrifice or circumferential wrap/clip reconstruction to reinforce the dissected segment produced good outcomes. Patients treated with aneurysm wrapping may show dramatic angiographic improvement of the dissected segment.

• Authors: Eric S Nussbaum, Michael T Madison, Mark E Myers, James Goddard, Tariq Janjua
• Journal: Journal of neurosurgery (J Neurosurg) Vol. 109 Issue 1 Pg. 23-7 (Jul 2008) ISSN: 0022-3085 [Print] United States
• PMID: 18590429 (Publication Type: Journal Article)

Topics

• Adult
• Aortic Dissection (complications, diagnosis, surgery)
• Cerebellum (blood supply)
• Cerebral Angiography
• Cerebral Revascularization
• Embolization, Therapeutic
• Female
• Follow-Up Studies
• Humans
• Intracranial Aneurysm (complications, diagnosis, surgery)
• Male
• Middle Aged
• Retrospective Studies
• Subarachnoid Hemorrhage (diagnosis, etiology, therapy)
• Treatment Outcome