Radiometric Study on Posterior Inferior Cerebellar Aneurysms with Special Reference to Accessibility by the Lateral Suboccipital Approach

Abstract

Radiometric studies were conducted in 21 cases of posterior inferior cerebellar aneurysms and 52 normal subjects to determine the variability of location of the vertebral-posterior inferior cerebellar artery complex in the posterior fossa. Accessibility using a lateral suboccipital approach was evaluated in relation to the radiometric data. Lateral sub occipital openings offered a sufficient surgical field in all cases under minimal retraction of the cerebellum and the results were satisfactory. The range of accessibility of this lateral approach was between 0 to 17 mm from the midline , 1 to 23 mm from the foramen magnum, 6 to 16 mm from the clivus and 35 to 61 mm from the posterior clinoid process. Postoperative neurological deficits were seen in patients with an aneurysm within 10 mm of the midline and at more than 13 mm from the clivus. Advantages of the lateral suboccipital approach are discussed.

11 Endovascular Treatment of Posterior Circulation Aneurysms

“…Lee et al (Lee et al 1989) describe a series of 14 patients with 11 excellent outcomes postoperatively (79%) and 2 deaths. Others describe similarly good results (Yamaura et al 1981;Salcman et al 1990). In a review of the literature on peripheral PICA aneurysms a 83% rate of good or excellent outcome was found with a mortality of about 1% (Beyerl and Heros 1986).…”

Posterior Inferior Cerebellar Artery Aneurysm: Microsurgical Clipping of a Ruptured Posterior Inferior Cerebellar Artery (PICA) Aneurysm Not Well Suited to Endovascular Treatment, Far-Lateral Transcondylar Approach to the Anterior Medullary Segment of the PICA, Complete Exclusion of the Aneurysm with Preservation of the Parent Artery

“…In autopsy series, the PICA has been reported to arise from 14 mm below to 28 mm above the foramen magnum, and a higher rate of postoperative cranial nerve palsies has been observed in aneurysms located within 10 mm of the midline (Yamaura et al 1981). Therefore, thorough imaging interpretation is vital, and the authors recommend use of CTA and DSA in the evaluation of PICA aneurysms.…”

Clip Reconstruction for a Case of Peripheral Posterior Inferior Cerebellar Artery Aneurysm: Case Report

“…One involved transposition of the PICA to the vertebral artery using a superficial temporal artery graft and in the other an end−to−end anastomosis of the PICA was done. The surgical approaches to peripheral PICA aneurysms are well known [1,6,8,19,20]. A midline suboccipital craniotomy is usually enough to expose the telovelotonsillar segment of the PICA [13].…”