Why are Aneurysms of the Posterior Inferior Cerebellar Artery so Unique? Clinical Experience and Review of the Literature

Abstract

The clinical, radiographical and surgical approaches to PICA aneurysms still represent a challenge.

Posterior Inferior Cerebellar Artery Aneurysms: Incidence, Clinical Presentation, and Outcome of Endovascular Treatment

“…Despite these problems, overall results of surgery of PICA aneurysms are good. [1][2][3][4][5][6][7][8] In experienced hands, PICA revascularization procedures can be performed in selected cases with good results. 8 In the treatment of PICA aneurysms, a multimodality approach tailored to the specific aneurysm in the specific patient seems even more appropriate than for aneurysms at other locations.…”

“…Surgery for these aneurysms is challenging due to the deep location and intimate relation with the medulla and cranial nerves IX, X, and XI. [1][2][3][4][5][6][7][8] Although endovascular treatment of intracranial aneurysms is increasingly used as an alternative to surgery, endovascular results of PICA aneurysms are not well established. [9][10][11][12] In this study, we report our experience with endovascular treatment of 47 proximal PICA aneurysms in 46 patients.…”

Dissecting Aneurysms of the Distal Segment of the Posterior Inferior Cerebellar Arteries: Clinical Presentation and Management

“…Most reported cases have been treated by surgery, with direct clipping, wrapping, or trapping with or without bypass. 6 More recently, several small series or case reports have been published that illustrate successful endovascular management. Endovascular treatment decreases the risks associated with manipulating the brain stem and cranial nerves during surgery.…”

Detachable Coil Embolization for Saccular Posterior Inferior Cerebellar Artery Aneurysms

“…One result showed that, although postoperative lower cranial nerve palsies occurred in about half of patients most resolved gradually during follow-up 1) . PICA aneurysm patients treated using microsurgery generally show good outcomes 1,3,6,[10][11][12]14,21) . Treatment modality should be considered on a case-by-case basis, without bias.…”

“…There is considerable variation in the PICA origin from the VA 2,4,15) . The infrequency of PICA aneurysms, complexity of PICA anatomy, and relatively difficult surgical access make treatment of PICA aneurysms a challenge 10) . Thorough analysis of the relevant anatomical details for each patient with a PICA aneurysm is crucial for successful treatment by surgical or endovascular approaches.…”