Original ArticleEndovascular Treatment of Posterior Inferior Cerebellar Artery Aneurysms with Flow Diversion
Introduction
Aneurysms of the posterior inferior cerebellar artery (PICA) are uncommon, representing 0.5%–3% of all intracranial aneurysms.1, 2 Flow diversion is an attractive option for reducing flow to wide-necked and fusiform aneurysms originating from the PICA, but coverage of the PICA and vertebral perforating arteries may be a concern. The purpose of this study was to examine the procedural, clinical, and angiographic outcomes of patients with PICA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic, Minneapolis, Minnesota, USA).
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Materials and Methods
Retrospective review of the neurointerventional databases of 3 high-volume neurovascular centers was approved by respective institutional review boards to identify patients with PICA aneurysms treated with the PED between January 2012 and July 2017. Each participating institution performs >100 endovascular aneurysm treatments per year and has deployed >200 PEDs. Demographic, clinical, and angiographic data were collected from electronic medical records. Patient functional status before and
Patient and Aneurysm Characteristics
During the study period, 14 PICA aneurysms in 14 patients were treated with 16 procedures. The cohort included 2 men and 12 women, with a mean age of 66.2 years (range, 41–76 years). Table 1 summarizes pertinent demographic and aneurysm characteristics. There were 11 saccular aneurysms with a mean size of 7.4 mm (range, 2.0–11.1 mm) and 3 fusiform aneurysms with a mean diameter of 6.1 mm (range, 5.0–8.0 mm) and mean length of 10.3 mm (range, 6.0–15.0 mm). The aneurysms involved dominant
Surgical Treatment of PICA Aneurysms
The primary challenge of surgical treatment of PICA aneurysms stems from their deep location and close proximity to the brainstem and lower cranial nerves.1, 3 In a recent case series of surgically treated PICA aneurysms, 48% (25 of 52) of patients developed postoperative lower cranial nerve palsies. Three of these patients (12%; 3 of 25) had long-term disability, whereas the remaining patients recovered within 3–9 months.4 Patients with postoperative lower cranial nerve palsies are at risk of
Conclusions
Flow diversion of PICA aneurysms is a safe and viable treatment option when traditional endovascular options are unlikely to preserve parent vessel patency.
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Outcomes and Complications After the Use of the Pipeline Embolization Device in the Treatment of Intracranial Aneurysms of the Posterior Circulation: A Systematic Review and Meta-Analysis
2019, World NeurosurgeryCitation Excerpt :Previous case series have reported on the feasibility and efficacy of endovascular treatment with PED for these patients. These facts are supported by the high obliteration and low complication rates achieved after the using this approach in most studies.11-16 Nevertheless, more recent large studies reported that compared with anterior circulation aneurysms, posterior circulation aneurysms treated by PED had higher procedure-related morbidity and mortality.17,18
Microsurgical and endovascular treatment of posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis
2023, Journal of Neurosurgical Sciences
Conflict of interest statement: J.E. Delgado is a consultant for Medtronic, MicroVention, Accriva Diagnostics, Penumbra, and Sequent Medical. Y. Kayan is a consultant for Medtronic, MicroVention, and Penumbra. C.J. Moran is a consultant for Medtronic and MicroVention. The remaining authors have no conflicts of interest to disclose.