Microsurgical operation of posterior inferior cerebellar artery aneurysms

Abstract

Objective To investigate the clinical efficacy of surgical operations of posterior inferior cerebellar artery (PICA) aneurysms at varying locations with various approaches. Methods A total of 29 patients with PICA aneurysms underwent microsurgical clip ligation at the Center of Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University from September 2011 to August 2016 and their data were retrospectively analyzed. Based on the locations of aneurysms, the patients were treated with ligation or resection of aneurysms through far lateral suboccipital approach (12 cases), suboccipital median approach (7 cases) and suboccipital retrosigmoid approach (10 cases). The clinical presentations, surgical procedures and treatment outcomes in this series were summarized post operation. Results Among all 29 aneurysms, 25 cases were completely clipped, 1 case was partially clipped and reinforced , 1 case was completely resected, resection of malformation rather than aneurysm was conducted in 1 case, and end-to-end anastomosis following aneurysm resection was performed in 1 case. Two cases of subcutaneous effusion were treated with debridement and suturing, 1 case died, vegetative state was reported in 1 case, and 11 cases developed disorders related to posterior group of cranial nerves such as difficulty in swallowing or hoarseness. Seventeen patients had no postoperative neurological dysfunction. No remaining aneurysm were found in 32 patients (76%) at imaging follow-up. At 6 to 63 months post operation, patients had improvement in their symptoms related to posterior group of cranial nerves. According to the Glasgow Outcome Scale (GOS), grade Ⅴ was achieved in 26 cases, Ⅳ in 1 case, Ⅲ in 0 case, Ⅱ in 1 case and Ⅰ in 1 case. Conclusions Surgical operations, through different approaches, of PICA aneurysms at varying locations could lead to good clinical outcomes. Preoperative study of shapes of PICA and pathological characteristics of aneurysms is important for the choice of surgical management. Despite relatively high rate of immediate post-operative complications, long-term follow-up results seemed to be satisfactory. Key words: Intracranial aneurysm; Posterior inferior cerebellar artery; Microsurgery; Treatment outcome