Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;11(1):34-43.
doi: 10.1055/s-0039-3399486. Epub 2020 Jan 27.

Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature

Harsh Deora  1 , Nitish Nayak  2 , Priyadarshi Dixit  2 , V Vikas  2 , K V L Narasinga Rao  2 , Nupur Pruthi  2 , Dwarakanath Srinivas  2 , Dhaval P Shukla  2 , Dhananjay I Bhat  2 , Bhaskara Rao Malla  2 , Bhagvatula Indira Devi  2 , Sampath Somanna  2
Affiliations

Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature

Harsh Deora et al. J Neurosci Rural Pract. 2020 Jan.

Abstract

Background Posterior inferior cerebellar artery (PICA) is a tortuous, variable, and uncommon site for aneurysms. Surgical management of PICA aneurysms involves careful selection of approach based on the location of the aneurysm and meticulous dissection of the neurovascular structures and perforators. Materials and Methods We did a retrospective review of all the PICA aneurysms operated at our institute in the past 10 years along with the site, presentation, and approach used for the same. Preoperative World Federation of Neurosurgical Society scores and follow-up modified Rankin scores (mRS) were also evaluated. During the same period, data for intervention cases of PICA aneurysm were also collected with follow-ups for a comparative analysis. Results A total of 20 patients with 21 PICA aneurysms were reviewed. All the reviewed cases presented with subarachnoid hemorrhage, and the most common location was the lateral medullary segment and vertebral artery (VA)-PICA junction. Midline approaches were used for distal PICA cases, with far-lateral approach reserved for anterior medullary/VA-PICA junction. No lower cranial nerve palsies were recorded at follow-up. Four cases needed cerebrospinal fluid diversion and two developed cerebellar infarcts. All cases were mRS 0 to 2 at follow-up. Conclusion Our series compares well with some of the larger surgical series of PICA aneurysms. This may be due to early referral patterns and early surgery (<24 hours) policy at our institution. Anatomical knowledge of PICA anatomy and sound perioperative management are keys to good outcomes in these cases.

Keywords: far-lateral approach; posterior inferior cerebellar artery aneurysm; subarachnoid hemorrhage; suboccipital approach.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Schematic representation of the normal anatomy of (left) posterior inferior cerebellar artery. AICA, anterior inferior cerebellar artery; BA, basilar artery; P1, anterior medullary segment; P2, lateral medullary segment; P3, tonsillo-medullary segment; P4: telovelotonsillar segment; P5, cortical segment; PCA, Posterior cerebellar artery; SuCA, superior cerebellar artery; VA, vertebral artery.
Fig. 2
Fig. 2
Preoperative plain computed tomography scan showing presentation of a case with extensive subarachnoid hemorrhage.
Fig. 3
Fig. 3
Preoperative plain computed tomography scan showing presentation of case with subarachnoid hemorrhage and preoperative hydrocephalus mandating extraventricular drain placement.
Fig. 4
Fig. 4
Preoperative digital subtraction angiography showing saccular aneurysm in the 4th segment of posterior inferior cerebellar artery.
Fig. 5
Fig. 5
( A ) Preoperative digital subtraction angiography of multiple aneurysm case showing medially directed supraclinoid inferior cerebellar artery aneurysm and another anterior communicating segment aneurysm. ( B ) Preoperative digital subtraction angiography of multiple aneurysm case showing a double posterior inferior cerebellar artery aneurysm, with one in the tonsillomedullary segment and the other in the cortical segment.
Fig. 6
Fig. 6
Postoperative digital subtraction angiography showing clip in situ with complete obliteration of aneurysm sac.
Fig. 7
Fig. 7
( A ) Diagnostic cerebral angiogram of cortical segment posterior inferior cerebellar artery aneurysm with vermian arteriovenous malformation-saccular aneurysm from the 5th segment. ( B ) Diagnostic cerebral angiogram of cortical segment posterior inferior cerebellar artery aneurysm with vermian arteriovenous malformation.
See this image and copyright information in PMC

Comment in

  • Personalized Approach to the Treatment of Posterior Inferior Cerebellar Artery Aneurysms doi: 10.1055/s-0039-1700793

References

    1. Bacigaluppi S, Bergui M, Crobeddu E, Garbossa D, Ducati A, Fontanella M. Aneurysms of the medullary segments of the posterior-inferior cerebellar artery: considerations on treatment strategy and clinical outcome. Neurol Sci. 2013;34(04):529–536. - PubMed
    1. Rodríguez-Hernández A, Lawton M T. Anatomical triangles defining surgical routes to posterior inferior cerebellar artery aneurysms. J Neurosurg. 2011;114(04):1088–1094. - PubMed
    1. Lister J R, Rhoton A L, Matsushima T, Jr, Peace D A. Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery. 1982;10(02):170–199. - PubMed
    1. Dandy W E. Ithaca, New York: Comstock Publishing Co., Inc; 1947. Intracranial Aneurysms.
    1. Rizzoli H V, Hayes G J. Congenital berry aneurysm of the posterior fossa; case report with successful operative excision. J Neurosurg. 1953;10(05):550–551. - PubMed