Abstract
Background: Aneurysms of the posterior inferior cerebellar artery (PICA) are rare lesions. The
anatomical behaviour of the artery itself is complex and characterised by a multitude
of variations. The same holds true for the aneurysms discovered there. Dissecting
aneurysms can be found from the PICA origin to the distal artery berry. They have
a wider range of clinical and radiographical presentations and their surgical treatment
requires more than one standard approach.
Methods: We encountered 14 patients with PICA aneurysms within two surgical series of a total
of 1345 cerebral aneurysm patients (1 %). In this patient group of the last 27 years
only 3 of the 14 were distal aneurysms (“true” PICA aneurysms)
Results: The 14 patients harboured 15 aneurysms (9 right-sided and 6 left-sided). The female/male
ratio of the patients was 9/5, the mean age 52.7 years. 13 of them had sustained an
SAH. 7/14 patients were hypertensive, in 10 patients at least one of putative cerebrovascular
risk factors was found. From the 15 aneurysms treated, 11 were typical berry aneurysms,
4 dissecting aneurysms. The aneurysms ranged in size from 5 to 20 mm (mean 9.1). 11
aneurysms were located within the anterior medullary segment, 1 in the tonsillomedullary
and 2 in the telovelomedullary segments. All patients were surgically treated, 10
in a semi-sitting position via a suboccipital craniotomy, 4 in the prone position.
13 aneurysms were clipped, two were treated differently. Two patients died due to
their bad preoperative clinical status.
Conclusions: The clinical, radiographical and surgical approaches to PICA aneurysms still represent
a challenge.
Key words
Aneurysm - incidence - posterior inferior cerebellar artery - subarachnoidal - haemorrhage
- surgical approach
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Dr. Gunther Kleinpeter
Neurochirurgie · Donauspital
Langobardenstrasse 122
1220 Wien
Austria
Phone: +43-1-28802-3602
Fax: +43-1-28802-3680
Email: g.kleinpeter@billrothhaus.at