Document Detail

Distal posterior inferior cerebellar artery aneurysms: clinical characteristics and surgical management.
MedLine Citation:
PMID:  16052289     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Aneurysms located on the distal posterior inferior cerebellar artery (PICA) are rare, and their underlying clinical features and surgical management are poorly understood. We report our series of 16 patients with 18 distal PICA aneurysms. METHOD: All patients with distal PICA aneurysms were treated between March 1996 and August 2004. We excluded all PICA aneurysms that involved the vertebral artery. Patients were analysed in the light of their clinical profiles, radiological studies, intraoperative findings and outcomes. All patients underwent non-enhanced and contrast enhanced CT scans followed by 4-vessel cerebral angiography on admission. The hemorrhagic patterns on initial CT scans were assessed using the Fisher Grading Score. The outcomes were documented using the Glasgow Outcome Scale at time of discharge and at three or twelve months follow-up. FINDINGS: The series included 6 men and 10 women. Massive intraventricular haemorrhage was found in 13 patients with proven CT subarachnoid haemorrhage, one patient revealed SAH without intraventricular components, one presented with only intraventricular blood in the occipital horns and 3 aneurysms were found incidentally without presence of blood. Fourteen aneurysms were saccular and four were fusiform. Nine cases were associated with another cerebrovascular lesion. A lateral transcondylar or a median suboccipital approach was used to secure the aneurysms in 15 patients, either by direct clipping (14 lesions) or vessel sacrifice (3 lesions). One aneurysm was treated by an endovascular approach. At long-term follow up, an excellent or good outcome was achieved in 75% of cases. One patient died due to pre-existing cardiopulmonary complications. CONCLUSIONS: Most of our cases of ruptured distal PICA aneurysms presented with haematocephalus. These were frequently associated with another vascular abnormality and 22% were fusiform or multilobulated. These specific features require special management strategies entailing an appropriate surgical approach to the aneurysm, clipping method, haematoma removal, ventricular drainage and when suitable choice of endovascular interventions.
B Orakcioglu; B Schuknecht; N Otani; N Khan; H G Imhof; Y Yonekawa
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2005-08-01
Journal Detail:
Title:  Acta neurochirurgica     Volume:  147     ISSN:  0001-6268     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-17     Completed Date:  2006-10-04     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  1131-9; discussion 1139     Citation Subset:  IM    
Department of Neurosurgery, Universitätsspital Zurich, Switzerland.
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MeSH Terms
Cerebellar Diseases / pathology,  physiopathology,  surgery
Cerebellum / blood supply*,  pathology
Cerebral Angiography
Cerebral Arteries / physiopathology*,  surgery*
Cerebral Ventricles / pathology,  physiopathology
Intracranial Aneurysm / diagnosis,  physiopathology*,  surgery*
Lateral Medullary Syndrome / diagnosis,  physiopathology,  surgery
Middle Aged
Neurosurgical Procedures / methods*,  statistics & numerical data
Postoperative Complications / epidemiology
Retrospective Studies
Subarachnoid Hemorrhage / diagnosis,  physiopathology
Surgical Instruments / statistics & numerical data
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures / methods*,  statistics & numerical data
Vertebral Artery / pathology,  radiography,  surgery

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