Vertebral artery-posterior inferior cerebellar artery convergence aneurysms treated by endovascular or surgical treatment: Mid- and long-term outcome

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• 作者：R. Aboukaï ; s^a ; ^{rabihdoc@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; F. Zairi^a ; F. Boustia^b ; P. Bourgeois^a ; X. Leclerc^b ; J.-P. Lejeune^a
• 关键词：PICA ; Aneurysm ; Endovascular ; Microsurgery
• 刊名：Neurochirurgie
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：62
• 期：2
• 页码：72-77
• 全文大小：575 K

文摘

Management of vertebral artery-posterior inferior cerebellar artery convergence (VA-PICA) saccular aneurysms requires a specialized neurovascular team. The objective is to preserve the functional outcome while performing a complete and reliable long-term exclusion of the aneurysm.

Objective

The aim of our study was to evaluate the outcome of patients with VA-PICA saccular aneurysms after treatment.

Materials and methods

This was a retrospective series of 21 consecutive patients with a VA-PICA saccular aneurysm treated between 2000 and 2012 at our institution. Treatment option (endovascular or microsurgical) was decided for each patient following a multidisciplinary discussion.

Results

Twenty-one patients were treated for a VA-PICA saccular aneurysm including 16 for a ruptured aneurysm and 5 for an asymptomatic aneurysm. Among all patients, 11 underwent endovascular treatment and 10 had microsurgical treatment. Our results showed a major aneurysm recurrence after endovascular treatment in 3 patients that required a further endovascular treatment in 2 cases. These 3 major recurrences occurred after treatment of a ruptured aneurysm when the initial angiography demonstrated the origin of the PICA at the neck of the aneurysm. After microsurgery, angiography showed a remnant neck in 2 patients including 1 treated by further endovascular procedure.

Conclusion

VA-PICA aneurysms are rare and require multidisciplinary management. Microsurgical treatment should be discussed when the PICA originates from the aneurysmal neck, particularly in patients with a ruptured small aneurysm, in order to obtain a reliable and long-term exclusion of the aneurysm.