Detachable Coil Embolization for Saccular Posterior Inferior Cerebellar Artery Aneurysms

Abstract

Objective : Surgical treatment of posterior inferior cerebellar artery (PICA) aneurysms is challenging due to limited surgical accessibility. Endovascular approach has a benefit of avoiding direct injury to the brainstem or lower cranial nerves. Therefore, it has recently been considered an alternative or primary modality for PICA aneurysms. We retrospectively assessed outcomes following detachable coil embolization of saccular PICA aneurysms. Methods : From February 1997 to December 2007, we performed endovascular procedures to treat 15 patients with 15 PICA aneurysms. Fourteen patients with 14 PICA aneurysms morphology of which was saccular were reviewed retrospectively. Twelve patients had ruptured aneurysms. The aneurysms arose from the PICA origin site (n = 12), the PICA lateral medullary segment (n = 1), or the PICA tonsilomedullary segment (n = 1). Results : Complete aneurysm occlusion was achieved in 10 patients, residual neck in 3, and residual sac in one. Radiological follow-up was performed in 7 patients with mean duration of 34.7 months (range, 1-97 months) and showed stable or complete occlusion in 6 patients. There were no rebleeding or retreatment after endovascular treatment. Thromboembolism was the only procedure-related complication (n = 4 ; 28.6%). Asymptomatic PICA infarction occurred in two patients and symptomatic PICA infarction in two elderly patients with poor clinical grade. Of these procedural PICA infarction cases, 1 symptomatic PICA infarction patient developed ventriculitis and septic shock leading to death. The clinical outcome was good in 10 patients (71.4%). Conclusions : In the present study, detachable coil embolization has shown as an efficient modality for PICA saccular aneurysms challenging indications of microsurgery. However, thromboembolic complications should be considered, especially in poor clinical elderly patients with ruptured aneurysms.

Endovascular treatment of posterior inferior cerebellar artery aneurysms: a 7-year single-center experience

“…Selective embolization of saccular aneurysms with a favorable geometry (narrow neck) can be safely and effectively performed with coils 3 9 13 19 23 24 29. For wide-necked aneurysms or when the PICA originates from the aneurysm sac, balloon remodeling or stent-assisted coiling and the waffle-cone technique can be used 14 15 27 31 36.…”

“…Thus, occlusion of the aneurysm and distal PICA has been our preferred method for the treatment of PICA aneurysms distal to the telovelotonsillar segment. Some authors insist that coil occlusion of the aneurysm including the PICA origin should be considered for aneurysms into which the PICA was incorporated because the clinical outcome is usually good 3 11 19. Although some patients develop more extensive collateral circulation than others, it is very difficult to predict which patients are at risk of procedural-related ischemic events.…”

Endovascular Treatment of Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysm. Report of Two Exemplary Cases and Retrospective Analysis of 11 Cases

“…PICA aneurysms usually develop at the VA-PICA junction. 12,16 The reported incidence of VA-PICA aneurysm is 0.5 to 3% of all intracranial aneurysms and 20% of those in the vertebrobasilar system. 5,7,9,11 A distal PICA aneurysm was defined by Lewis et al 17 as arising from more peripheral PICA segments not including the VA-PICA junction.…”

“…1,2,8,10,11 Alternatively, endovascular treatment is becoming more frequently used in the treatment of surgically inaccessible or difficult lesions; distal PICA lesions have been treated endovascularly applied for the same reasons. 8,[12][13][14] Although there are recent publications concerning endovascular treatment, no precise information is available in the literature regarding the management of ruptured distal PICA aneurysm specifying an endovascular technique. In an effort to provide effective treatment options for patients with a high-risk distal PICA aneurysm, we retrospectively analyzed 11 consecutive patients harboring a ruptured distal PICA aneurysm chosen for endovascular treatment.…”

Technical Consideration for Coiling of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm

“…This is because the proximal PICA allows only for a too narrow surgical view, as it is filled with subarachnoid hematomas, is surrounded by brain stem perforation arteries, and contains major cranial nerves [ 2 ]. By contrast, coil embolization based on an intravascular approach can reportedly be used with relative easy to treat these lesions because it avoids the neighboring cranial nerves and subarachnoid hematomas [ 1 , 4 ]. However, as proximal PICA may lead to an anatomical diversity of shapes when it meets its parent artery (vertebral artery [VA]), it is essential to understand the diversity in using coil embolization to treat lesions in the proximal PICA and to develop diverse strategies for coil embolization.…”