Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature
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 perforator...
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doaj-45f900a5f8aa43f5967b9907e3b79c3b2021-04-02T10:59:51ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neurosciences in Rural Practice0976-31470976-31552020-01-01110103404310.1055/s-0039-3399486Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of LiteratureHarsh Deora0Nitish Nayak1Priyadarshi Dixit2V. Vikas3K. V. L. Narasinga Rao4Nupur Pruthi5Dwarakanath Srinivas6Dhaval P. Shukla7Dhananjay I. Bhat8Bhaskara Rao Malla9Bhagvatula Indira Devi10Sampath Somanna11Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaBackground 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-3399486far-lateral approachposterior inferior cerebellar artery aneurysmsubarachnoid hemorrhagesuboccipital approach |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Harsh Deora Nitish Nayak Priyadarshi Dixit V. Vikas K. V. L. Narasinga Rao Nupur Pruthi Dwarakanath Srinivas Dhaval P. Shukla Dhananjay I. Bhat Bhaskara Rao Malla Bhagvatula Indira Devi Sampath Somanna |
spellingShingle |
Harsh Deora Nitish Nayak Priyadarshi Dixit V. Vikas K. V. L. Narasinga Rao Nupur Pruthi Dwarakanath Srinivas Dhaval P. Shukla Dhananjay I. Bhat Bhaskara Rao Malla Bhagvatula Indira Devi Sampath Somanna Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature Journal of Neurosciences in Rural Practice far-lateral approach posterior inferior cerebellar artery aneurysm subarachnoid hemorrhage suboccipital approach |
author_facet |
Harsh Deora Nitish Nayak Priyadarshi Dixit V. Vikas K. V. L. Narasinga Rao Nupur Pruthi Dwarakanath Srinivas Dhaval P. Shukla Dhananjay I. Bhat Bhaskara Rao Malla Bhagvatula Indira Devi Sampath Somanna |
author_sort |
Harsh Deora |
title |
Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature |
title_short |
Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature |
title_full |
Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature |
title_fullStr |
Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature |
title_full_unstemmed |
Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature |
title_sort |
surgical management and outcomes of aneurysms of posterior inferior cerebellar artery: location-based approaches with review of literature |
publisher |
Thieme Medical and Scientific Publishers Pvt. Ltd. |
series |
Journal of Neurosciences in Rural Practice |
issn |
0976-3147 0976-3155 |
publishDate |
2020-01-01 |
description |
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. |
topic |
far-lateral approach posterior inferior cerebellar artery aneurysm subarachnoid hemorrhage suboccipital approach |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-3399486 |
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