Predicting Factors Affecting Clinical Outcomes for Saccular Aneurysms of Posterior Inferior Cerebellar Artery with Subarachnoid Hemorrhage

Abstract

study that analyzed the predicting factors of clinical outcome 13) . We experienced 20 patients for PICA aneurysms with subarachnoid hemorrhage (SAH). And so, we investigated the clinical outcomes after surgery and endovascular treatment and tried to find the predicting factors affecting the outcomes for ruptured PICA aneurysms. MATERIALS AND METHODS Patient populationsBetween April 1996 and December 2010, 1960 intracranial aneurysms were treated at our institution. Among them, we retrospectively reviewed 20 patients of PICA aneurysms with SAH, of which there were 18 females and 2 males with a mean age of 55.9 (range 42-86 years). In our study, all aneurysms were included except fusiform and dissecting aneurysms. Among them, eleven cases were treated with surgical clipping and 9 cases were treated with endovascular treatment. Patients' data include age, sex, side and location of aneurysm, initial HuntHess (H-H) grade, procedure-related complications, follow-up duration, and Glasgow Outcome Scale (GOS) at last follow-up visit. According to GOS, we categorized the two groups into good (GOS 4 and 5) and poor (GOS 1-3) for the statistical anal- INTRODUCTIONIn view of location, posterior inferior cerebellar artery (PICA) aneurysms are reported to most frequently occur in the region where PICA originates in the vertebral artery (VA) 8,12) . When surgical clipping is performed, there are some risks of neurological complications because of the intimate anatomical relationships of the proximal PICA to the brain stem and lower cranial nerves 2,4,11) . Because of difficulty in general anesthesia due to poor general condition, recent advancement in endovascular surgery, and difficulties related with surgery, endovascular treatment is being used as a primary or alternative method for treating these aneurysms 3,6) . For ruptured or unruptured PICA aneurysms, in our knowledge, many authors 2,4,7,8,14,15) reported the clinical outcomes of surgery or endovascular treatment, but there was only one Results : Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. Conclusion : In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.

A Case of Ruptured Distal Posterior Inferior Cerebellar Artery Aneurysm Treated with Intra-aneurysmal Coil Embolization

“…8) Another study that compared direct surgery and endovascular treatment reported that the factors related to poor outcomes were the severity of the subarachnoid hemorrhage and the presence or absence of acute hydrocephalus, and they reported that there was no difference in the outcomes between direct surgery and endovascular treatment. 6) Our patient also showed a rapid decline in the level of consciousness accompanied by marked intraventricular hematoma after rupture, suggestive of a rapid increase in posterior cranial fossa pressure, as described in previous reports. In addition, Sejkorová et al 15) reported that ruptured distal PICA aneurysms should be treated early after the onset because the re-rupture rate before treatment was found to be higher for these aneurysms as compared to aneurysms at other sites, such as supratentorial aneurysms.…”

“…The general sites of PICA aneurysms are classified as follows: 1) the anterior medullary segment, 2) lateral medullary segment, 3) tonsillomedullary segment, 4) telovelotonsillar segment, and 5) cortical segment. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] On the basis of this classification, we evaluated the factors to be considered while selecting the treatment methodology.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The number of reports on the use of endovascular treatments for PICA aneurysms has increased recently; however, an endovascular procedure should be selected after individual patient assessment as the PICA has several anatomical variations, has a small diameter, and has considerable tortuosity. In the case presented here, we treated a distal PICA aneurysm accompanied by subarachnoid hemorrhage by performing intra-aneurysmal coil embolization while preserving the parent artery.…”

Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

“…There is information about Op-Mo in 14 of them, but only 9 of them contain events [11,14,16,22,24,[26][27][28][29]. Twelve contain information about PND and 11 of them demonstrate events [11,12,14,17,[22][23][24][26][27][28][29]. Out of the 10 articles giving information about La-Mo, there is only two including an event [18,22].…”

“…The articles which were excluded from that article pool were those which focused on the reoperation management, case reports, systematic reviews, unrelated outcome, co-morbidities, experimental techniques, or one of the two techniques and all those which demonstrated mixed or unclear results, being separated between anterior and posterior circulation. The final article pool contained 20 articles, as appropriate for our meta-analysis [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Fig. 1).…”