Introduction: Aneurysms of the posterior inferior cerebellar artery (PICA) are a rare cause of subarachnoid hemorrhage. Furthermore, their treatment is challenged by a high proportion of fusiform aneurysms and the tortousity of the PICA. Similar to other intracranial aneurysms, the choice of surgical vs. endovascular treatment depends on patient characteristics and clinician expertise.
Methods: A single-center retrospective review of patients admitted to Vancouver General Hospital (VGH) with symptomatic PICA aneurysms. Due to advances in endovascular management in the past two decades, data collection was limited to patients admitted between 2005 and 2015. Variables collected include patient demographics, clinical presentation, treatment complications and length of stay (LOS).
Results: A total of 54 patients were admitted with symptomatic aneurysms during the study period. 39 patients underwent microsurgical clipping/trapping of the aneurysm and 11 patients had endovascular treatment. The remaining patients only had a diagnostic cerebral angiogram. Analysis of our data suggests a higher mortality rate among coiling patients and a trend toward longer LOS in patients undergoing surgical clipping.
Conclusions: We present a large series of patients who have undergone treatment for PICA aneurysms. Our institutional experience is fairly unique among Canadian centers in the preponderance of surgical management. Given the small sample size, individual patient characteristics likely have the greatest influence on outcomes. However, our data suggests a slightly higher mortality rate among patients undergoing coiling.
Patient Care: Adds to the body of reported outcomes for patients with PICA aneurysms treated surgically or endovascularly.
Learning Objectives: By the conclusion of this session participants should be able to identify patient characteristics which may affect outcomes of surgical clipping or coiling.