![]() ![]() Nineteen patients were females and the average age was 43 years (range 18–69). The angiographic outcome was evaluated on the basis of the complete exclusion of the aneurysm at the sixth-month follow-up. The outcome evaluation was also reported according to the clinical onset and the involved PICA segment. Overall neurological outcome was reported as good, moderate, severe, and death, on the basis of an mRS score of 0–2, 3–4, 5, and 6, respectively. Factors affecting the choice of the approach were also analyzed. Proximal aneurysms were defined as those arising from the vertebral artery-PICA junction to the tonsillo-medullary segment, the remnants being been considered as distal. Aneurysms were classified according to the five PICA segments reported by Lister et al. Only patients harboring saccular aneurysms were selected and retrospectively reviewed. The aim of this retrospective study is to analyze the results of 25 PICA aneurysms surgically treated, mainly focusing on the choice of the approach and technical nuances.īetween 20, 25 patients harboring 25 PICA aneurysms were surgically treated by the senior author (R.G.) at two institutions: San Salvatore City Hospital, L’Aquila, Italy, and Foundation IRCCS Policlinico San Matteo, Pavia, Italy. Since then, several reports on the surgical management of PICA aneurysms were published, but only a few of them were based on a large patient’s cohort. In 1953, Rizzoli and Hayes first reported successful surgical treatment of a PICA aneurysm operated in 1947. Because of the proximity to the lower cranial nerves and frequent involvement of perforating arteries from the proximal segments, both microsurgical and endovascular treatment of PICA aneurysms are challenging. According to Lister et al., five segments are classically described. ![]() PICA has a complex and variable course among all of the intracranial arteries, it has a small diameter, projecting along the brainstem and cerebellum. The saccular geometry is usually the most frequent, but dissecting or fusiform aneurysms are also relatively more common than in other cerebral arteries. Most are left-sided due to the prevalence of the vertebral artery. However, they are most common within the posterior circulation ones after those of the basilar tip. Their incidence accounts for 0.49–3% of all intracranial aneurysms. Given the high anatomical variability of both PICA and patients’ bony anatomy, a case-by-case meticulous preoperative imaging evaluation is mandatory for the choice of the most suitable and tailored surgical corridor which, in turn, is pivotal to achieve the best outcome. At 6-month follow-up, 60% of patients had a modified Rankin Score (mRS) of 0–2. Twenty-three aneurysms underwent direct treatment consisting of clip ligation. Trans-condylar or trans-tubercular variants were rarely necessary and however reserved to peculiar cases. Nineteen were proximal, all of these being been treated through a far-lateral approach. ![]() Twenty-five patients, harboring a single aneurysm, were operated on. Demographics, charts, videos, outcome, and follow-up of a cohort of PICA aneurysms managed in the last 10 years were retrospectively analyzed, focusing only upon those treated with microneurosurgery. The reported is study aimed at a critical review of the overall results of a personal series of PICA aneurysms, treated by the senior author, R. The complex anatomy of PICA and its intimate relationships with medulla, lower cranial nerves, and jugular tubercle makes the surgical treatment of these aneurysms fascinating. Aneurysms of the posterior inferior cerebellar artery (PICA) are uncommon. ![]()
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