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Treatment strategies of ruptured posterior inferior cerebellar artery aneurysm according to its segment.

ABSTRACT: The aim of this study was to evaluate the clinical outcomes between endovascular treatment (EVT) and surgery of the ruptured posterior inferior cerebellar artery (PICA) aneurysms and suggest proper management strategies according to the PICA segment.We retrospectively analyzed clinical and radiological data of patients with ruptured PICA aneurysms who underwent surgery or EVT from three different institutes. Clinical outcomes were evaluated by mRS.We collected 39 consecutive patients with 39 ruptured PICA aneurysms; 26 patients were with proximal segment aneurysm and 13 patients were with distal. Of the 26 proximal PICA aneurysms, 20 aneurysms were treated with EVT and 6 aneurysms were treated with surgery. EVT seemed to have more favorable clinical outcome (mRS 0-2; mean mRS, 1.75 for EVT vs 3.50 for surgery, P = 0.152). Of the 13 distal PICA aneurysms, 7 aneurysms were treated with EVT and 6 were treated with surgery. Surgery showed more favorable clinical outcome (mean mRS, 2.63 for EVT vs 0.33 for surgery, P = 0.023) and lower procedure-related complication rate (42.9% for EVT vs 0% for surgery, P = 0.046) than EVT.For the treatment of ruptured PICA aneurysms, EVT seemed to have more favorable outcomes for proximal segment, while surgery showed more favorable outcomes for distal segment. Additional experience and follow-up are needed in a larger series to state the efficacy of this strategy.

SUBMITTER: Song J

PROVIDER: S-EPMC5535566 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Intractable Hiccups Due to Posterior Inferior Cerebellar Artery Aneurysm.

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Project description:BackgroundIn the endovascular era, most of vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms were mainly treated with endovascular procedures. This study aimed to demonstrate the microsurgical treatment via the far-lateral approach without C1 laminectomy and its clinical outcomes.MethodsForty-eight patients with VA and proximal PICA aneurysms treated by microsurgery through the far-lateral approach without C1 laminectomy, between January 2016 and June 2021, were retrospectively evaluated.ResultsMost patients (87.5%) presented with subarachnoid hemorrhage. Grading at presentation was poor in 41.7%. The rates of VA dissecting aneurysms, saccular aneurysms of the VA-PICA junction, and true PICA saccular aneurysms were 54.2, 18.7, and 14.6%, respectively. All aneurysms were located above the lower margin of the foramen magnum. The far-lateral approach without C1 laminectomy was successfully used in all patients without residual aneurysms. Various surgical strategies were applied depending on the characteristics of the aneurysm. Good outcomes 3 months postoperatively were achieved in 77.1% and 89.3% for the overall and good-grade groups, respectively.ConclusionsMicrosurgery is a safe and effective treatment of VA and proximal PICA aneurysms. Moreover, the far-lateral approach without C1 laminectomy was adequate and effective for aneurysms located above the lower border of the foramen magnum.

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Project description:BackgroundIsolated posterior inferior cerebellar artery dissections can cause subarachnoid hemorrhages or infarctions. Surgical and endovascular treatments for hemorrhagic stroke cases and medical treatments using antithrombotic agents for ischemic stroke cases have been performed, but there are very few reports on nonstroke isolated posterior inferior cerebellar artery dissections, and the treatment strategy for nonstroke cases has not been established.Case presentationA 48-year-old healthy male felt a severe, throbbing headache on the right side and came to our clinic on the fourth day following onset. MRI examinations revealed a right posterior inferior cerebellar artery dissection and showed no infarctions or hemorrhages. He was observed carefully with continuous monitoring of blood pressure, hydrated sufficiently, and given analgesic anti-inflammatory agents. Two weeks later, the dissected vessel's diameter grew to the maximum size, though the patient's headache rapidly improved around that day. Surgical or endovascular treatments for prevention of subarachnoid hemorrhage were recommended, but careful conservative therapy was continued in accordance with the patient's wishes. Gradually, the dissection finding improved. Four months later, MRI examinations showed his right posterior inferior cerebellar artery was almost normal in size and shape.ConclusionsThis is the first detailed report on a nonstroke isolated posterior inferior cerebellar artery dissection that spontaneously occurred and healed, observed by serial high-resolution MRI examinations.

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Resolution of an anterior-inferior cerebellar artery feeding aneurysm with the treatment of a transverse-sigmoid dural arteriovenous fistula.

Project description:A 27-year-old man developed an unruptured anterior-inferior cerebellar artery (AICA) feeding aneurysm from a transverse-sigmoid dural arteriovenous malformation. The patient, with a known history of left transverse and sigmoid sinus thrombosis, presented with pulse-synchronous tinnitus. Angiography revealed an extensive dural arteriovenous fistula (AVF), with feeders from both the extracranial and intracranial circulations, involving the right transverse sinus, the torcula, and the left transverse/sigmoid sinuses. Multimodal endovascular and open surgical therapy was used to manage the lesion. Before a planned second-stage treatment for the left sigmoid sinus component, the dural AVF improved significantly. During this interval, however, a small flow-related aneurysm developed on the left AICA feeding the petrous dural region. The aneurysm resolved after resection of the involved sigmoid sinus. This is the first reported case of an unruptured feeding-artery aneurysm in an intracranial dural AVF that resolved spontaneously with treatment of the dural AVF. Until more is known about the natural history, the decisions of when and whether to treat an unruptured dural AVF feeding-artery aneurysm must be made on an individual basis.

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