TY - JOUR
T1 - Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex
T2 - Variations on a theme
AU - Salcman, M.
AU - Rigamonti, D.
AU - Numaguchi, Y.
AU - Sadato, N.
PY - 1990
Y1 - 1990
N2 - Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex are relatively uncommon lesions. They include aneurysms at the origin of the posterior inferior cerebellar artery (PICA-VA), aneurysms on the distal artery (PICA) and aneurysms at the junction of the vertebral and basilar arteries (VA-BA). We have had the opportunity to treat 17 patients and study the radiological records of 9 additional patients in the past 8 years. The aneurysms ranged in size from 3 to 30 mm, with mean values of 10.6, 7.3, and 9 mm for PICA-VA lesions, distal PICA lesions, and VA-BA lesions, respectively. Three of the 4 VA-BA aneurysms were located at the midline, and the mean distance of the PICA-VA aneurysms from the midline was 7.6 to 9.4 mm; 2 aneurysms crossed the midline from their parent VA. The aneurysms were located slightly more often on the left side (left:right ratio, 1:2), were found more frequently in women (2.25:1), and occurred at a mean age of 50 years. Ten aneurysms at the origin of the PICA and 4 VA-BA aneurysms were treated via a lateral suboccipital craniectomy; 3 distal PICA aneurysms were exposed by a midline craniectomy. Surgery was carried out acutely in 5 patients. Tortuousness of the VA required contralateral approaches in 2 patients, an exploratory craniectomy in 1 patient, and an approach toward the dome of 1 patient with a VA-BA aneurysm. Morbidity was primarily due to cranial nerve dysfunction. There were no perioperative deaths. These aneurysms can easily be missed on initial radiographic examination; one appeared only on the second study, one was seen to grow over 16 days, and one was discovered at the level of C1 extracranially. Our radiographic and surgical approach to the treatment of these lesions is presented.
AB - Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex are relatively uncommon lesions. They include aneurysms at the origin of the posterior inferior cerebellar artery (PICA-VA), aneurysms on the distal artery (PICA) and aneurysms at the junction of the vertebral and basilar arteries (VA-BA). We have had the opportunity to treat 17 patients and study the radiological records of 9 additional patients in the past 8 years. The aneurysms ranged in size from 3 to 30 mm, with mean values of 10.6, 7.3, and 9 mm for PICA-VA lesions, distal PICA lesions, and VA-BA lesions, respectively. Three of the 4 VA-BA aneurysms were located at the midline, and the mean distance of the PICA-VA aneurysms from the midline was 7.6 to 9.4 mm; 2 aneurysms crossed the midline from their parent VA. The aneurysms were located slightly more often on the left side (left:right ratio, 1:2), were found more frequently in women (2.25:1), and occurred at a mean age of 50 years. Ten aneurysms at the origin of the PICA and 4 VA-BA aneurysms were treated via a lateral suboccipital craniectomy; 3 distal PICA aneurysms were exposed by a midline craniectomy. Surgery was carried out acutely in 5 patients. Tortuousness of the VA required contralateral approaches in 2 patients, an exploratory craniectomy in 1 patient, and an approach toward the dome of 1 patient with a VA-BA aneurysm. Morbidity was primarily due to cranial nerve dysfunction. There were no perioperative deaths. These aneurysms can easily be missed on initial radiographic examination; one appeared only on the second study, one was seen to grow over 16 days, and one was discovered at the level of C1 extracranially. Our radiographic and surgical approach to the treatment of these lesions is presented.
KW - aneurysm
KW - posterior inferior cerebellar artery
KW - subarachnoid hemorrhage
KW - vertebral artery
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U2 - 10.1227/00006123-199007000-00002
DO - 10.1227/00006123-199007000-00002
M3 - Article
C2 - 2377268
AN - SCOPUS:0025280819
SN - 0148-396X
VL - 27
SP - 12
EP - 21
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -