Revascularization treatment for complex proximal posterior inferior cerebellar artery aneurysms

Abstract

Objective To evaluate the clinical effect of revascularization on the treatment of complex proximal posterior inferior cerebellar artery (PICA) aneurysms. Methods A retrospective analysis was conducted on 10 cases (accounting for 5.1% of 10/198 cases of PICA aneurysm admitted during the same period) of complex proximal PICA aneurysms (10 aneurysms) who were admitted to Neurosurgical Department of Tianjin Huanhu Hospital from June 2008 to January 2018. According to the morphological characteristics and collateral circulation of aneurysms, various ways of revascularization were undergone. Eight cases underwent occipital artery (OA)-PICA anastomosis + aneurysm trapping; vertebral artery (VA) occlusion + OA-PICA anastomosis was performed in 1 case; aneurysm depression and PICA in situ anastomosis was performed in 1 case. The patency of anastomotic vessels and postoperative complications were observed after operation and the patients' outcomes were evaluated with modified Rankin scale (mRS). Results Ten cases successfully underwent the blood flow reconstruction. Intraoperative fluorescein angiography revealed the patency of anastomotic vessels. Two cases developed hoarseness post operation and fully recovered to normal after treatment. One patient developed dyspnea and pulmonary infection 3 days post operation and fully recovered to normal after treatment. Ten cases were followed up effectively. The follow-up period was 3-118 months after operation. No recurrent or ruptured aneurysms were found in the follow-up period. One patient died of cerebral hemorrhage because of hypertension after 12 months. Ventriculoperitoneal drainage was performed in 1 case of hydrocephalus. Nine cases of anastomotic vessels were patent and 1 case showed occlusion. All aneurysms disappeared. The score of mRS was 0 in 8 cases, 1 in 1 and 6 in 1. Conclusions Depending on the morphological characteristics and collateral circulation, different revascularization techniques are selected. Revascularization is an effective method for the treatment of complex proximal PICA aneurysms in terms of relief of space-occupying effect and removal of aneurysms. Key words: Intracranial aneurysm; Neurosurgical procedures; Prognosis; Posterior inferior cerebellar artery; Revascularization