On the basis of the anatomy, an estimate of each individual patient’s ability to tolerate occlusion of the PICA was made. A diagnostic angiogram was obtained to define the vascular anatomy of the posterior fossa and assess collateral supply from the anterior inferior cerebral artery (AICA) and superior cerebellar artery (SCA). A 6F guiding catheter (Cordis, Miami Lakes, Fla) was introduced through a femoral sheath to the vertebral artery. Vascular access was obtained via the common femoral artery. The procedures were performed with the patient under general anesthesia and monitored by using pulse oximetry and electrocardiography. To our knowledge, this is the largest reported series of such cases.ĭiagnosis and endovascular treatment were performed in our neuroradiology interventional suite, equipped with a Philips biplane digital unit (Philips Medical Systems, Bothell, Wash) with road-mapping and 3D capabilities. 5, 10, 15, 16 We present our experience with endovascular treatment of 6 additional dissecting PICA aneurysms by occlusion of the aneurysm and parent artery. There are only 4 reported cases in the medical science literature of endovascular treatment of isolated dissecting PICA aneurysm. 14 Recently, endovascular treatment has been proposed as an alternative to surgery. 2– 13 Traditionally, surgical treatment included surgical wrapping, clip ligation, or trapping (with or without anastomosis) 2, 3, 7, 8, 10– 13 however, these surgical procedures carry a high risk of neurologic complications due to the proximity of the aneurysm to vital structures such as the brain stem and cranial nerves. 1, 2 Isolated dissecting aneurysms of the PICA are rare. Most arise near the origin of the PICA from the vertebral artery. Follow-up studies showed stable and complete occlusion of the aneurysm in all patients with no long-term neurologic deficits.ĬONCLUSIONS: Endovascular treatment by aneurysm and parent artery occlusion is a relatively safe and reliable alternative to surgery for isolated dissecting aneurysms of the PICA.Īneurysms of the posterior inferior cerebellar artery (PICA) are uncommon, accounting for 0.5%–1% of all intracranial aneurysms. RESULTS: In all patients, the aneurysm was successfully occluded with no apparent procedure-related complications. Four additional cases, which have been described in the literature, were included in the analysis of results. When on the basis of the anatomy, potential lack of sufficient collaterals was suggested, a test occlusion was performed to determine the feasibility of an endovascular approach. Inclusion of patients in the study was based on careful angiographic assessment of the vascular anatomy and collateral supply of the posterior fossa. METHODS: Six patients (age range, 28–70 years) with dissecting aneurysms of the PICA were treated at our center by endovascular occlusion with Guglielmi detachable coils or glue and followed for up to 30 months. The purpose of this article is to show that endovascular treatment of dissecting aneurysms of the PICA can be effective and can allow the patient to avoid the complications associated with surgery. Surgical treatment carries a significant risk of neurologic complications, predominantly lower cranial nerve deficits because of the close relationship of the aneurysm with the brain stem and cranial nerves. Although rare, they present a therapeutic challenge. BACKGROUND AND PURPOSE: Isolated dissecting aneurysms of the posterior inferior cerebellar artery (PICA) carry a high risk of rebleeding with an associated increased mortality rate.
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