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Acta Neurochir (Wien). 2019 Apr 26. doi: 10.1007/s00701-019-03894-5. [Epub ahead of print]

Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study.

Author information

1
Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.
2
Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland. rodolfo.maduri@gmail.com.
3
Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland.
4
Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
5
Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland.
6
Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland.
7
Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany.
8
Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.
9
Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland.
10
Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
11
Department of Neurosurgery, Baylor Medical Center and College of Medicine, Houston, TX, USA.
12
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
13
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
14
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospital (HUG), Geneva, Switzerland.
15
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
16
Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland.
17
Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
18
Lausanne Institute for Clinical Epidemiology and Biostatistics, University Hospital Lausanne (CHUV), Lausanne, Switzerland.
19
University of Lausanne (UniL), Lausanne, Switzerland.

Abstract

BACKGROUND AND PURPOSE:

Aneurysms of the posterior inferior cerebellar artery (PICA) are relatively uncommon and evidence is sparse about patients presenting with ruptured PICA aneurysms. We performed an analysis of the Swiss SOS national registry to describe clinical presentation, treatment pattern, and neurological outcome of patients with ruptured PICA aneurysms compared with other ruptured posterior circulation (PC) aneurysms.

METHODS:

This was a retrospective analysis of anonymized data from the Swiss SOS registry (Swiss Study on Aneurysmal Subarachnoid Hemorrhage; 2009-2014). Patients with ruptured PC aneurysms were subdivided into a PICA and non-PICA group. Clinical, radiological, and treatment-related variables were identified, and their impact on the neurological outcome was determined in terms of modified Rankin score at discharge and at 1 year of follow-up for the two groups.

RESULTS:

Data from 1864 aneurysmal subarachnoid hemorrhage patients were reviewed. There were 264 patients with a ruptured PC aneurysm. Seventy-four PICA aneurysms represented 28% of the series; clinical and radiological characteristics at admission were comparable between the PICA and non-PICA group. Surgical treatment was accomplished in 28% of patients in the PICA group and in the 4.8% of patients in the non-PICA group. No statistically significant difference was found between the two groups in terms of complications after treatment. Hydrocephalus requiring definitive shunt was needed in 21.6% of PICA patients (p = 0.6); cranial nerve deficit was present in average a quarter of the patients in both PICA and non-PICA group with no statistical difference (p = 0.3). A more favorable outcome (66.2%) was reported in the PICA group at discharge (p < 0.05) but this difference faded over time with a similar neurological outcome at 1-year follow-up (p = 0.09) between both PICA and non-PICA group. The Kaplan-Meyer estimation showed no significant difference in the mortality rate between both groups (p = 0.08).

CONCLUSIONS:

In the present study, patients with ruptured PICA aneurysms had a favorable neurological outcome in more than two thirds of cases, similar to patients with other ruptured PC aneurysms. Surgical treatment remains a valid option in a third of cases with ruptured PICA aneurysms.

KEYWORDS:

Aneurysmal subarachnoid hemorrhage; Endovascular procedures; Hydrocephalus; Intracranial aneurysms; Intracranial vasospasm; Posterior circulation; Posterior inferior cerebellar artery

PMID:
31025178
DOI:
10.1007/s00701-019-03894-5

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