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AJNR - American Journal of Neuroradiology

Published ahead of print on October 10, 2007
doi: 10.3174/ajnr.A0758

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American Journal of Neuroradiology 29:86-90, January 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Posterior Inferior Cerebellar Artery Aneurysms: Incidence, Clinical Presentation, and Outcome of Endovascular Treatment

J.P. Peluso^a, W.J. van Rooij^a, M. Sluzewski^a, G.N. Beute^b and C.B. Majoie^c

^a Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
^b Department of Neurosurgery, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
^c Department of Radiology, Academisch Medisch Centrum, Amsterdam, the Netherlands

Please address correspondence to Willem Jan van Rooij, MD, PhD, Department of Radiology, St. Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands; e-mail: radiol{at}knmg.nl

BACKGROUND AND PURPOSE: Results of endovascular treatment of PICA aneurysms are not well established. The purpose of this study was to report incidence, clinical presentation, and outcome of endovascular treatment in 46 patients with 47 posterior inferior cerebellar artery (PICA) aneurysms.

MATERIALS AND METHODS: Of 2169 aneurysms treated between January 1995 and March 2007, 60 were located on the PICA (incidence, 2.8%). Forty-seven proximal PICA aneurysms in 46 patients were treated with endovascular techniques, 37 ruptured (79%) and 10 unruptured (21%). Four patients presented with lower cranial nerve palsies. Mean aneurysm size was 6.8 mm (median, 6 mm; range, 2–32 mm). Forty-three aneurysms were occluded with coils (6 including the PICA origin), and 4 were treated with proximal vertebral artery (VA) occlusion.

RESULTS: Four aneurysms treated with proximal VA occlusion were not occluded. Procedural rupture occurred in 9 aneurysms leading to death in 2 patients and to permanent disability in 1 patient. One patient developed lateral medullary and cerebellar infarctions after PICA occlusion. Combined mortality and morbidity was 8.6% (4 of 46). Outcome at 6 months in 38 surviving patients was good in 35 and moderate in 3. No hemorrhage occurred during 109 patient-years of follow-up. Symptoms of mass effect resolved in all 4 patients.

CONCLUSION: In our experience, PICA aneurysms were challenging lesions, prone to procedural rupture. In some instances, endovascular treatment required occlusion of the parent PICA; usually this was well tolerated. In other instances, treatment required occlusion of the VA. Although this was effective in alleviation of symptoms of mass effect, it was not effective in causing thrombosis of the aneurysm.

This article has been cited by other articles:

				J.-M. Isokangas, T. Siniluoto, T. Tikkakoski, and T. Kumpulainen Endovascular Treatment of Peripheral Aneurysms of the Posterior Inferior Cerebellar Artery AJNR Am. J. Neuroradiol., October 1, 2008; 29(9): 1783 - 1788. [Abstract] [Full Text] [PDF]