Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: A comparison of endovascular and microsurgical clip ligation

Bradley N. Bohnstedt, Mary Ziemba-Davis, Gary Edwards, Jacqueline Brom, Troy D. Payner, Thomas J. Leipzig, John A. Scott, Andrew J. Denardo, Erin Palmer, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background The vicinity of brainstem and cranial nerves as well as the limited operative working space make clip ligation of posterior inferior cerebellar artery (PICA) aneurysms challenging. The small caliber of the PICA and the broad neck often associated with these aneurysms also create challenges in preserving this artery during treatment. Few data exist to compare the 2 treatment approaches for aneurysms in this location. Object To assess treatment outcomes for PICA aneurysms based on mode of management and anatomical location. Methods A prospectively maintained database was queried for PICA aneurysms treated from 2000 through 2012. Patients were categorized on the basis of their aneurysm's anatomical location, presentation status, treatment modality, and subsequent complications. Descriptive, univariate, and multivariate statistical analyses were performed. Results A total of 113 PICA aneurysms were identified; 11 did not undergo treatment. Of the remaining 102 aneurysms, 77% were ruptured and 64% were treated microsurgically. In the ruptured group, patients with more proximally located aneurysms such as vertebral and proximal PICA aneurysms were more likely to experience hydrocephalus and cranial nerve deficits after treatment. Endovascular therapy was less likely to cause postoperative deficit or lead to a need for percutaneous endoscopic gastrostomy. Most importantly, discharge, 6-month, and 1-year outcomes were predicted based on presenting Hunt and Hess score and patient's age, not aneurysm location or management mode. Conclusions PICA aneurysms are challenging and require a multimodality treatment paradigm. Although microsurgery is associated with more short-term postoperative complications, presenting grade and patient's age remain the primary predictors of long-term outcome.

Original languageEnglish
Pages (from-to)784-793
Number of pages10
JournalWorld Neurosurgery
Volume83
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Surgical Instruments
Aneurysm
Ligation
Arteries
Cranial Nerves
Therapeutics
Gastrostomy
Microsurgery
Hydrocephalus
Brain Stem
Neck
Multivariate Analysis
Databases

Keywords

  • Aneurysm
  • Clip ligation
  • Coil embolization
  • Outcomes
  • Posterior inferior cerebellar artery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms : A comparison of endovascular and microsurgical clip ligation. / Bohnstedt, Bradley N.; Ziemba-Davis, Mary; Edwards, Gary; Brom, Jacqueline; Payner, Troy D.; Leipzig, Thomas J.; Scott, John A.; Denardo, Andrew J.; Palmer, Erin; Cohen-Gadol, Aaron.

In: World Neurosurgery, Vol. 83, No. 5, 01.05.2015, p. 784-793.

Research output: Contribution to journalArticle

Bohnstedt, BN, Ziemba-Davis, M, Edwards, G, Brom, J, Payner, TD, Leipzig, TJ, Scott, JA, Denardo, AJ, Palmer, E & Cohen-Gadol, A 2015, 'Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: A comparison of endovascular and microsurgical clip ligation', World Neurosurgery, vol. 83, no. 5, pp. 784-793. https://doi.org/10.1016/j.wneu.2014.12.035
Bohnstedt, Bradley N. ; Ziemba-Davis, Mary ; Edwards, Gary ; Brom, Jacqueline ; Payner, Troy D. ; Leipzig, Thomas J. ; Scott, John A. ; Denardo, Andrew J. ; Palmer, Erin ; Cohen-Gadol, Aaron. / Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms : A comparison of endovascular and microsurgical clip ligation. In: World Neurosurgery. 2015 ; Vol. 83, No. 5. pp. 784-793.
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AU - Brom, Jacqueline

AU - Payner, Troy D.

AU - Leipzig, Thomas J.

AU - Scott, John A.

AU - Denardo, Andrew J.

AU - Palmer, Erin

AU - Cohen-Gadol, Aaron

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N2 - Background The vicinity of brainstem and cranial nerves as well as the limited operative working space make clip ligation of posterior inferior cerebellar artery (PICA) aneurysms challenging. The small caliber of the PICA and the broad neck often associated with these aneurysms also create challenges in preserving this artery during treatment. Few data exist to compare the 2 treatment approaches for aneurysms in this location. Object To assess treatment outcomes for PICA aneurysms based on mode of management and anatomical location. Methods A prospectively maintained database was queried for PICA aneurysms treated from 2000 through 2012. Patients were categorized on the basis of their aneurysm's anatomical location, presentation status, treatment modality, and subsequent complications. Descriptive, univariate, and multivariate statistical analyses were performed. Results A total of 113 PICA aneurysms were identified; 11 did not undergo treatment. Of the remaining 102 aneurysms, 77% were ruptured and 64% were treated microsurgically. In the ruptured group, patients with more proximally located aneurysms such as vertebral and proximal PICA aneurysms were more likely to experience hydrocephalus and cranial nerve deficits after treatment. Endovascular therapy was less likely to cause postoperative deficit or lead to a need for percutaneous endoscopic gastrostomy. Most importantly, discharge, 6-month, and 1-year outcomes were predicted based on presenting Hunt and Hess score and patient's age, not aneurysm location or management mode. Conclusions PICA aneurysms are challenging and require a multimodality treatment paradigm. Although microsurgery is associated with more short-term postoperative complications, presenting grade and patient's age remain the primary predictors of long-term outcome.

AB - Background The vicinity of brainstem and cranial nerves as well as the limited operative working space make clip ligation of posterior inferior cerebellar artery (PICA) aneurysms challenging. The small caliber of the PICA and the broad neck often associated with these aneurysms also create challenges in preserving this artery during treatment. Few data exist to compare the 2 treatment approaches for aneurysms in this location. Object To assess treatment outcomes for PICA aneurysms based on mode of management and anatomical location. Methods A prospectively maintained database was queried for PICA aneurysms treated from 2000 through 2012. Patients were categorized on the basis of their aneurysm's anatomical location, presentation status, treatment modality, and subsequent complications. Descriptive, univariate, and multivariate statistical analyses were performed. Results A total of 113 PICA aneurysms were identified; 11 did not undergo treatment. Of the remaining 102 aneurysms, 77% were ruptured and 64% were treated microsurgically. In the ruptured group, patients with more proximally located aneurysms such as vertebral and proximal PICA aneurysms were more likely to experience hydrocephalus and cranial nerve deficits after treatment. Endovascular therapy was less likely to cause postoperative deficit or lead to a need for percutaneous endoscopic gastrostomy. Most importantly, discharge, 6-month, and 1-year outcomes were predicted based on presenting Hunt and Hess score and patient's age, not aneurysm location or management mode. Conclusions PICA aneurysms are challenging and require a multimodality treatment paradigm. Although microsurgery is associated with more short-term postoperative complications, presenting grade and patient's age remain the primary predictors of long-term outcome.

KW - Aneurysm

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KW - Coil embolization

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