Far-Lateral Approach Without Drilling the Occipital Condyle for Vertebral Artery–Posterior Inferior Cerebellar Artery Aneurysms

Seoane, Pablo; Kalb, Samuel; Clark, Justin C.; Rivas, Juan Carlos; Xu, David S.; Mendes, George A C; Preul, Mark C.; Zabramski, Joseph M.; Spetzler, Robert F.; Nakaji, Peter

doi:10.1093/neuros/nyw136

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…For many years, controversy has raged over the pros and cons of the various surgical routes to approach PICA aneurysms. The far-lateral approach is a standard approach for PICA aneurysms clipping 75 , 77 , 78 , 82 , 83 .…”

Section: Aneurysmmentioning

confidence: 99%

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Miao¹,

Zhang²,

Wang³

et al. 2020

Int. J. Med. Sci.

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The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. However, a comprehensive systematic review of the importance of the PICA is currently lacking. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. The PICA has tortuous and variable course and territory, divided into 5 segments. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. PICA injured by head trauma can cause fatal SAH. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. In conclusion, PICA is very important in clinical practice.

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Section: Aneurysmmentioning

confidence: 99%

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Miao¹,

Zhang²,

Wang³

et al. 2020

Int. J. Med. Sci.

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“…We agree with those authors who believe that the resection of condyles is unnecessary in the vast majority of cases. [24,28] In some cases, the optimal surgical view may be achieved through intradural jugular tuberclectomy. [2,17,27]…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Pilipenko¹,

Eliava²,

Okishev³

et al. 2019

Surgical Neurology International

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Background: The choice of surgical approaches and options for the microsurgical vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms repair remains controversial. Methods: A retrospective analysis of the clinical, surgical, and angiographic data of 80 patients with VA and PICA aneurysms treated from 2012 to 2018 was performed. Results: The aneurysms were saccular in 50 cases (62.5%) and fusiform in 30 cases (37.5%). The median suboccipital craniotomy was the most common approach (73.8%). Retrosigmoid craniotomy was performed in 25% of patients. There were the following types of microsurgical operations: neck clipping (61.25%), clipping with the artery lumen formation (13.75%), trapping (10%), proximal clipping (5%), and deconstruction with anastomosis (10%). Fifty-seven (71.3%) patients were discharged without worsening of the clinical signs after surgery. The most common postoperative neurological disorder was palsy of IX and X cranial nerve revealed in 14 (17.5%) patients. No fatal outcomes or patients in vegetative state were identified. The complete occlusion of PICA and VA aneurysms according angiography was in 77 (96.3%) cases. Conclusion: Microsurgical treatment is an effective method for VA and PICA aneurysms. The majority of VA and PICA aneurysms do not require complex basal approaches. A thorough preoperative planning, reconstructive clipping techniques, and anastomoses creation, as well as patient selection based on the established algorithms and consultations with endovascular surgeons, may reduce the number of complications and increase the rate of complete microsurgical occlusion in VA and PICA aneurysms.

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“…18 Another recent report of a modified far-lateral approach without condyle resection in 56 patients with VA and PICA aneurysms reported that this less-invasive approach also offers excellent surgical exposure, with complete occlusion rate achieved in all patients and good clinical outcome (Glasgow Outcome Scale score 4e5) achieved in 52 patients (93%). 43 Our series comprises 52 consecutive cases with a comparable favorable outcome of 100% in unruptured and 71% in good-grade patients.…”

Section: Discussionmentioning

confidence: 99%

Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms: A Study of 52 Cases Over 10 Years

et al. 2017

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Far-Lateral Approach Without Drilling the Occipital Condyle for Vertebral Artery–Posterior Inferior Cerebellar Artery Aneurysms

Abstract: A far-lateral approach that leaves the occipital condyle intact is adequate for treating most patients with VA-PICA aneurysms.

Cited by 22 publications

References 24 publications

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Vertebral artery and posterior inferior cerebellar artery aneurysms: Results of microsurgical treatment of eighty patients

Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms: A Study of 52 Cases Over 10 Years

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