Clinical evaluation of endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms

Öz

Aim: PICA aneurysms are rare. A significant proportion of the patients present with hemorrhage. Endovascular treatment is replacing the surgical treatment particularly within the last two decades. Anatomical difficulties of the PICA origin is the reason of disfficulties in surgical and endovascular treatment options.

Material and Methods: In the present study, clinical and angiographical analysis of 17 patients with PICA aneurysms whom were treated at Ankara Numune Education and Research Hospital between 2014 and 2018 were analyzed.

Results: Of 17 patients 15 were female and two of them were male. Four patients had associated aneurysms at other intracranial localizations. Aneurysms were saccular in 13 and fusiform dissecting in 4 patients. Mean diameter of the aneurysms was 8.5 mm in fusiform dissecting type and 11.4 mm in saccular type. Primary coiling was performed in 2, stent assisted coiling in 5 and flow diverter treatment was primary treatment modality in 10 patients.  

Conclusion: In the present study of 17 PICA aneurysms, flow diverters were the main treatment modality among endovascular treatment options with improved clinical results. 

Anahtar Kelimeler

• PICA aneurysm,endovascular treatment,flow diverters,angiography

Endovasküler tedavi uygulanan posterior inferior serebellar arter (PICA) anevrizmalarının klinik değerlendirilmesi

Öz

Amaç: PICA (posterior inferior serebellar arter) anevrizmaları nadir intrakranial anevrizmalar olup olguların önemli bir kısmı kanama ile prezente olur. Özellikle son iki dekadda PICA anevrizmalarının tedavisinde daha çok endovasküler yöntemler öne çıkmaktadır. PICA orijininin anatomik yapısından dolayı endovasküler ve cerrahi tedavide güçlükler yaşanmaktadır.

Gereç ve Yöntemler: Bu çalışmada Ankara Numune Eğitim ve Araştırma Hastanesinde 2014-2018 yılları arasında endovasküler yöntemlerle tedavi edilen 17 PICA anevrizma olgusunun klinik ve anjiyografik özellikleri incelenmektedir.

Bulgular: Toplam 17 olgunun 15’i bayan 2’si erkek olup yaş ortalamaları 53.5 olarak tespit edilmiştir. Dört olguda eşlik eden diğer inrakranial lokalizasyonlarda anevrizmaya rastlanmıştır. Olguların dördünde anevrizma fuziform disekan tipte iken diğer 13 olguda anevrizma saküler tipte idi. Fuziform disekan anevrizmaların çap ortalamaları 8.5 mm iken saküler tip anevrizmaların çap ortalaması ise 11.4 mm idi. Toplam 2 olguda primer koilleme yapılırken, 5 olguda stent eşliğinde koilleme ve ikisi çift seans olmak üzere toplam 10 olguda akım yönlendiriciler tedavide kullanılmıştır.

Sonuç: Bu çalışmada PICA anevrizması nedeni ile tedavi edilen 17 olguda sıklıkla akım yönlendiricilerin tercih edildiği endovasküler tedaviler ile başarılı klinik sonuçlar elde edilmiştir. 

Anahtar Kelimeler

• PICA anevrizması,endovasküler tedavi,akım yönlendiriciler,anjiyografi

Kaynakça

1. 1. Lewis SB, Chang DJ, Peace DA, Lafrentz PJ, Day AL. Distal posterior inferior cerebellar artery aneurysms: Clinical features and management. J Neurosurg 2002; 97: 756-66.
2. 2. Mericle RA, Reig AS, Burry MV, Eskioglu E, Firment CS, Santra S. Endovascular surgery for proximal posterior inferior cerebellar artery aneurysms: An analysis of Glasgow Outcome Score by Hunt-Hess grades. Neurosurgery 2006; 58: 619-25.
3. 3. Bradac GB, Bergui M. Endovascular treatment of the posterior inferior cerebellar artery aneurysms. Neuroradiology 2004; 46: 1006-11.
4. 4. Kim DS, Kang SG, Yoo DS, Huh PW, Cho KS, Park CK. Ruptured right posterior inferior cerebellar artery aneurysm associated with hypoplasia of the right vertebral artery and both internal carotid arteries. Br J Neurosurg 2009; 23: 551-53.
5. 5. Saito N, Kamiyama H, Takizawa Ket al. Management strategy for bilateral complex vertebral artery aneurysms. Neurosurg Rev 2016; 39: 289-96.
6. 6. Horowitz M, Kopitnik T, Landreneau F, Krummerman J, Batjer HH, Thomas G, Samson D. Posteroinferior cerebellar artery aneurysms: surgical results for 38 patients. Neurosurgery 1998; 43: 1026-32.
7. 7. Foster MT, Herwadkar A, Patel HC. Posterior Inferior Cerebellar Artery/Vertebral Artery Subarachnoid Hemorrhage: A Comparison of Saccular vs Dissecting Aneurysms. Neurosurgery 2018; 82: 93-98.
8. 8. Hudgins RJ, Day AL, Quisling RG, Rhoton AL Jr, Sypert GW, Garcia-Bengochea F. Aneurysms of the posterior inferior cerebellar artery. A clinical and anatomical analysis. J Neurosurg 1983; 58: 381-87.

9. 9. Kim J, Chang C, Jung YJ. Coil Embolization Results of the Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm: A Single-Center 10 Years' Experience. World Neurosurg 2018; 117: 645-52.
10. 10. Aronov M, Mokin M, Zelenkov A, Popugaev K, Tsarikaev A, Reutov A. Endovascular Coiling of Ruptured Very Small Dissecting Fusiform Aneurysm of Posterior Inferior Cerebellar Artery with Parent Artery Preservation by Microcatheter Auto-Assistance. World Neurosurg 2019; 121: 152-55
11. 11. Mahajan A, Goel G, Das B, Narang KS. Dissecting Aneurysm of Vertebral Artery Involving the Origin of Posteroinferior Cerebellar Artery Treated with Retrograde Stent Placement and Coil Embolization in the Era of Flow Diverter. Asian J Neurosurg 2018; 13: 910-13.
12. 12. Juszkat R, Kram P, Stanisławska K, Jankowski R, Stachowska-Tomczak B, Nowak S, Liebert W. Ten years of experience in endovascular treatment of ruptured aneurysms of the posterior inferior cerebellar artery. Interv Neuroradiol 2016; 22: 129-37.
13. 13. Williamson RW, Wilson DA, Abla AA, McDougall CG, Nakaji P, Albuquerque FC, Spetzler RF. Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: a comparative analysis. J Neurosurg 2015; 123: 441-45.
14. 14. Bhogal P, Chudyk J, Bleise C, Lylyk I, Henkes H, Lylyk P. The use of flow diverters to treat aneurysms of the posterior inferior cerebellar artery: Report of three cases. Interv Neuroradiol 2018; 24: 489-98.
15. 15. Bhogal P, Henkes E, Schob S et al. The use of flow diverters to treat small (≤5 mm) ruptured, saccular aneurysms. Surg Neurol Int 2018; 9: 216.