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Dissecting aneurysms of the posterior inferior cerebellar artery: retrospective evaluation of management and extended follow-up review in 6 patients Nussbaum ES; Madison MT; Myers ME; Goddard J; Janjua TJ Neurosurg 2008[Jul]; 109 (1): 23-7OBJECT: The authors report the management protocol and successful outcomes in 6 patients with dissecting aneurysms of the posterior inferior cerebellar artery (PICA). METHODS: Medical records and neuroimaging studies of 6 patients who underwent surgical treatment of dissecting PICA aneurysms were reviewed. The mean follow-up duration was 1.8 years. No patient was lost to follow-up review. RESULTS: Four patients presented with acute subarachnoid hemorrhage and 2 with PICA ischemia. All patients underwent surgery, which entailed proximal occlusion with distal revascularization in 3 cases and circumferential wrap/clip reconstruction in 3 cases. The revascularization techniques used were occipital artery-PICA bypass and PICA-PICA anastomosis. Delayed follow-up angiography was performed in all cases. In patients treated with proximal occlusion, delayed angiography showed minimal retrograde opacification of the dissected segments. The 3 patients treated with wrap/clip reconstruction showed unexpectedly significant normalization of their lesions on angiographic studies. Outcome was good in all cases. CONCLUSIONS: Dissecting PICA aneurysms are rare lesions with an apparent propensity for bleeding. Individualized management including distal revascularization with PICA sacrifice or circumferential wrap/clip reconstruction to reinforce the dissected segment produced good outcomes. Patients treated with aneurysm wrapping may show dramatic angiographic improvement of the dissected segment.|Adult[MESH]|Aortic Dissection/complications/*diagnosis/*surgery[MESH]|Cerebellum/*blood supply[MESH]|Cerebral Angiography[MESH]|Cerebral Revascularization[MESH]|Embolization, Therapeutic[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Intracranial Aneurysm/complications/*diagnosis/*surgery[MESH]|Male[MESH]|Middle Aged[MESH]|Retrospective Studies[MESH]|Subarachnoid Hemorrhage/diagnosis/etiology/therapy[MESH]|Treatment Outcome[MESH] |
