Patient and treatment characteristics of 37 ruptured PICA aneurysms (79%) are summarized in on-line Table 1 and of 10 unruptured PICA aneurysms (21%), in on-line Table 2. The present study group consists of 47 (proximal) PICA aneurysms in 46 patients treated with endovascular techniques. Of 55 PICA aneurysms that were treated endovascularly, 8 aneurysms in 7 patients were located distally on the PICA, and these aneurysms were excluded from analysis. Since the beginning of the study period, endovascular treatment was the therapy of choice for posterior circulation aneurysms and only 7 of 334 posterior circulation aneurysms were treated surgically, 5 of which were located on the PICA. Incidence of PICA aneurysms was 2.8% (60 of 2169) of all treated aneurysms and 18% (60 of 334) of posterior circulation aneurysms. Sixty aneurysms in 58 patients were located on the PICA. 9– 12 In this study, we report our experience with endovascular treatment of 47 proximal PICA aneurysms in 46 patients.īetween January 1995 and March 2007, 2169 aneurysms were treated in our institution, 940 surgically and 1229 endovascularly. 1– 8 Although endovascular treatment of intracranial aneurysms is increasingly used as an alternative to surgery, endovascular results of PICA aneurysms are not well established. Surgery for these aneurysms is challenging due to the deep location and intimate relation with the medulla and cranial nerves IX, X, and XI. Although this was effective in alleviation of symptoms of mass effect, it was not effective in causing thrombosis of the aneurysm.Īneurysms of the posterior inferior cerebellar artery (PICA) are rare. In other instances, treatment required occlusion of the VA. In some instances, endovascular treatment required occlusion of the parent PICA usually this was well tolerated. Symptoms of mass effect resolved in all 4 patients.ĬONCLUSION: In our experience, PICA aneurysms were challenging lesions, prone to procedural rupture. No hemorrhage occurred during 109 patient-years of follow-up. Outcome at 6 months in 38 surviving patients was good in 35 and moderate in 3. Combined mortality and morbidity was 8.6% (4 of 46). One patient developed lateral medullary and cerebellar infarctions after PICA occlusion. Procedural rupture occurred in 9 aneurysms leading to death in 2 patients and to permanent disability in 1 patient. RESULTS: Four aneurysms treated with proximal VA occlusion were not occluded. Forty-three aneurysms were occluded with coils (6 including the PICA origin), and 4 were treated with proximal vertebral artery (VA) occlusion. Mean aneurysm size was 6.8 mm (median, 6 mm range, 2–32 mm). Four patients presented with lower cranial nerve palsies. Forty-seven proximal PICA aneurysms in 46 patients were treated with endovascular techniques, 37 ruptured (79%) and 10 unruptured (21%). MATERIALS AND METHODS: Of 2169 aneurysms treated between January 1995 and March 2007, 60 were located on the PICA (incidence, 2.8%). The purpose of this study was to report incidence, clinical presentation, and outcome of endovascular treatment in 46 patients with 47 posterior inferior cerebellar artery (PICA) aneurysms. BACKGROUND AND PURPOSE: Results of endovascular treatment of PICA aneurysms are not well established.
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