Introduction: Posterior inferior cerebellar artery (PICA) aneurysms are uncommon. There are no comparative studies of surgical vs. endovascular treatment modalities for these lesions, which may hinder therapeutic decision making. Here we offer a multi-center series of surgical and endovascular treatment of PICA aneurysms.
Methods: Demographic and clinical data for 18 consecutive patients (age=61.2±13.1 y, 14F/4M) who underwent surgical or endovascular treatment of PICA aneurysms at MMC or VUMC between 2009 and 2013 were analyzed.
Results: Nine patients (50%) presented in the setting of acute subarachnoid hemorrhage (Hunt and Hess: I-II=2, III=4, IV=3). Two were clipped, five were coiled, and two were embolized with Onyx. Coiling failed in one case, which required surgical trapping. There were no procedure-related complications, and 8/9 (88.9%) achieved complete occlusion at last angiographic follow-up (5.5±7.9 mo). In the 9 unruptured cases, five were clipped, two were coiled primarily, one was stent-coiled, and one underwent flow diversion. The stent-assisted case required three-staged embolization to avoid stent prolapse into the wide-neck aneurysm. The only complication was pseudomeningocele (requiring revision) in a clipped aneurysm. Of unruptured cases, 8/9 (88.9%) achieved complete occlusion at last angiographic follow-up (12±16.9 mo). All unruptured cases were at modified Rankin scale 0-1 at last clinical follow-up.
Conclusions: In this highly selected small series, both coiling and clipping had high safety and effectiveness, with no significant differences between endovascular vs. coiling. Coiling may not achieve complete occlusion and may require additional intervention compared to clipped aneurysms. Clipping carries risks expected with any craniotomy. Large prospective studies are warranted to determine best intervention.
Patient Care: High quality data for best treatments of PICA aneurysms are lacking. This series demonstrates the safety and effectiveness of open and endovascular techniques.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Discuss treatment considerations for PICA aneurysms