Clinical Analysis and Treatment Result in Posterior Inferior Cerebellar Artery Aneurysms

Kim, Dal Soo; Baik, Min Woo; Lee, Sang Won; Rha, Hyung Kyun; Park, Young Sup; Huh, Pil Woo; Yang, Ji Ho; Ahn, Jae Geun; Yoo, Do Sung; Kang, Joon Ki

Abstract

OBJECTIVE
The purpose of this study is to characterize the Posterior Inferior Cerebellar Artery aneurysm distribution (location, age, sex, multiplicity and associated vascular anomalies), clinical presentation, neuroradiological findings and surgery outcome.
MATERIALS AND METHODS
From Jul. '96 to Jun. '99, the admission chart and radiologic study material of 24 cases of angiographically confirmed PICA aneurysm patients were reviewed, retrospectively.
RESULTS
Mean age of the patients was 53.4 years (ranged from 24 to 75), and majority of these aneurysms occurred in females (20 of 24). 22 of 24 patients presented with subarachnoid hemorrhage. The most common subarachnoid hemorrhage observed at ambient cistern, crural cistern, and the forth ventricular hemorrhage. In 19 of 24 cases the aneurysm size was 5+/-2 mm, and 23 cases show saccular aneurysm. PICA aneurysm patients have many associated intracranial vascular diseases (multiple aneurysm: 5, arteriovenous malformation: 2, abnormal vasculature: 4) and concomitant medical diseases (diabetes mellitus and tuberosclerosis). Direct surgical approaches were attempted in 22 cases (lateral suboccipital approach: 10, far lateral approach: 8, midline suboccipital: 2, pre-sigmoidal and combined approach in each case) and the surgical result was acceptable (favorable outcome: 19, unfavorable: 5).
CONCLUSIONS
Based on this study, the incidence of PICA aneurysm was 1.3% and shows female predominance. In 46%, intracranial vascular abnormality was associated. On brain CT examination, subarachnoid hemorrhage at peimesencephalic cistern and intraventricular hemorrhage at the forth ventricle were most frequent CT finding. In most surgical cases, lateral or farlateral suboccipital approach was a good surgical approach enough to reach the PICA aneurysm and the surgical result was acceptable.