In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Endovascular Treatment of Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms

    Final Number:
    1414

    Authors:
    Nohra Chalouhi; Stavropoula I. Tjoumakaris MD; Pascal Jabbour MD; L. Fernando Gonzalez MD; Robert H. Rosenwasser MD, FACS, FAHA; Aaron S. Dumont MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Surgical clipping of posterior inferior cerebellar artery (PICA) aneurysms is challenging and carries a potentially significant risk of morbidity and mortality. Experience with endovascular therapy has been limited to a few studies. We assess the safety and efficacy of endovascular therapy in the largest series of proximal and distal PICA aneurysms to date.

    Methods: A total of 50 patients, 39 with proximal and 11 with distal PICA aneurysms, underwent endovascular treatment at Jefferson Hospital for Neuroscience between 2004 and 2011.

    Results: Hunt and Hess Grades were 0 in 12 patients, I-II in 7 patients, III in 12 patients, and IV-V in 19 patients. Mean aneurysm size was 5.9 mm. Endovascular treatment was successful in 37 (95%) patients with proximal aneurysms and 8 (72%) patients with distal aneurysms. Selective aneurysm coiling was performed in 32 patients, proximal coil occlusion of the PICA in 6, balloon-assisted coiling in 4, and stent-assisted coiling in 3. There were 5 (11.1%) overall procedural complications, 4 (8.9%) cerebellar infarcts (2 occurring after deliberate coil occlusion of PICA) and 1 (2.2%) intra-procedural rupture. Procedure-related permanent morbidity and mortality were 2.2% and 0% respectively. Complete or near-complete aneurysm occlusion was achieved in 84.4% of patients. One patient (2.2%) treated with selective aneurysm coiling suffered a rehemorrhage on post-operative day 15. Aneurysm recanalization and retreatment rates were respectively 30% and 26% at a mean angiographic follow-up time of 18.2 months. Favorable outcomes (GOS 4 and 5) were seen in 100% of patients with unruptured aneurysms and 54.5% of those with ruptured aneurysms.

    Conclusions: Endovascular therapy is a feasible, safe and effective treatment in patients with proximal and distal PICA aneurysms. The long-term incidence of aneurysm recanalization is high and requires adequate angiographic follow-up.

    Patient Care: This is the largest study to assess the feasibility, safety and efficacy of endovascular therapy in patients with PICA aneurysms. The data provided will help neurosurgeons make evidence-based clinical decisions and optimize the management of these patients.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the advantages and limitations of endovascular therapy in the treatment of PICA aneurysms. 2) Optimize the management of patients with proximal and distal PICA aneurysms.

    References:

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy