Endovascular Treatment of Anterior Inferior Cerebellar Artery Aneurysms: A Single-Center Experience and Review of 33 Patients

Abstract

Objective: The aim of the present article was the demonstration of the institutional experience with the endovascular management of the anterior inferior cerebellar artery (AICA) aneurysms in order to propose a treatment algorithm. Methods: Clinical data were obtained from 33 patients with 37 AICA aneurysms who had been surgically treated at the authors’ hospital between 2010 and 2022. The patients’ medical records, imaging data, and follow-up outcomes were retrospectively analyzed. Results: All 33 patients (10 males, 23 females; mean age 54.88 ± 12.49 years) underwent endovascular therapy for AICA aneurysms. The most common chief complaints were headache (87.9%), nausea and vomiting (57.6%), and alteration of consciousness (27.3%). Thirty-one patients experienced subarachnoid hemorrhage. Regarding the AICA aneurysm location, 23 aneurysms were found at the right side of AICA in digital subtraction angiography images, and there were 6, 9, 16, 6 aneurysms in segments A1-A4, respectively. Coiling (59.5%), Onyx embolization (29.7%), coiling-combined Onyx embolization (5.4%), nonintervention (5.4%) were chosen in the surgical strategy. The length of follow-up was 8.09 ± 5.05 months, and 84.8% of the patients had favorable modified Rankin Scale (mRS) scores. The complete occlusion rates were 94.6%. Postoperative complications occurred in 4 cases (12.1%), including new neurological deficit in 3 cases and cerebral infarction in 1 case. One patient died after follow-up because of the severe pneumonia. Poor initial Hunt and Hess grade (HHG) (p = 0.007) was the risk factor for unfavorable clinical outcome. The rupture status (p = 0.025) and the location (p = 0.021) of the AICA aneurysms are statistically significant in determining which operation strategy to be chosen. Coiling had an advantage over Onyx embolization (p = 0.001) in parent artery preservation. Conclusions: In this study, an algorithm for the treatment of AICA aneurysms was proposed based on the clinical status of the patients before treatment, the anatomical factors of AICA, and the technical conditions of endovascular treatment (EVT). To our knowledge, this is the first study to report more than 30 cases of AICA aneurysms that had been treated by EVT and to advocate a treatment algorithm. EVT of AICA aneurysms is an optional strategy, but decisions are made based on the specific condition, anatomical location, and other factors.