Fatehi Mostafa, Rizzuto Michael A, Prakash Swetha, Haw Charles, Gooderham Peter A, Redekop Gary J
Division of Neurosurgery, Vancouver General Hospital, Vancouver, CAN.
Cureus. 2020 Nov 28;12(11):e11746. doi: 10.7759/cureus.11746.
Objective Aneurysms of the posterior inferior cerebellar artery (PICA) are a rare cause of subarachnoid hemorrhage. Treatment for this type of aneurysm may be microsurgical clipping or endovascular. This decision is based on patient characteristics, aneurysm location and dimensions, along with surgeon and institutional experience. In this study we aim to assess the outcomes of surgical and endovascular treatment of PICA aneurysms. Methods We retrospectively reviewed the charts of 52 patients who were admitted to Vancouver General Hospital for ruptured or symptomatic PICA aneurysms between 2005 and 2015. Modified Rankin scores were assigned at the time of discharge and at two subsequent follow-up time points. The mean short-term follow-up period post-operatively was 11.1 months and the mean long-term follow-up period was 19.3 months. Clinical and radiological characteristics were collected for all patients. Results Of the 52 patients, two died prior to obtaining treatment. Of the 50 patients who were treated for their PICA aneurysm, 39 presented with subarachnoid hemorrhage while 11 had symptomatic unruptured PICA aneurysms. Overall, 11 patients had endovascular treatment (coil embolization) while 39 patients underwent microsurgical clipping/trapping of the aneurysm. At the time of hospital discharge, patients in the microsurgical group trended towards a better the modified Rankin Scale score (2.3) compared to the endovascular group, though this did not reach significance (3.0) (p=0.20). The long-term score in the endovascular group (1.6) was also comparable to the microsurgical group (1.9) (p=0.55). Conclusion While the early outcomes in patients treated endovascularly appear better, there is no statistically significant difference in outcomes between the microsurgical and endovascular treatment groups at short- and long-term follow-up.
目的 小脑后下动脉（PICA）动脉瘤是蛛网膜下腔出血的罕见病因。此类动脉瘤的治疗方法可以是显微手术夹闭或血管内治疗。这一决策基于患者特征、动脉瘤位置和大小，以及外科医生和机构的经验。在本研究中，我们旨在评估PICA动脉瘤的手术和血管内治疗效果。方法 我们回顾性分析了2005年至2015年间因破裂或有症状的PICA动脉瘤入住温哥华总医院的52例患者的病历。出院时以及随后的两个随访时间点给予改良Rankin评分。术后短期平均随访期为11.1个月，长期平均随访期为19.3个月。收集所有患者的临床和影像学特征。结果 52例患者中，2例在接受治疗前死亡。在接受PICA动脉瘤治疗的50例患者中，39例表现为蛛网膜下腔出血，11例有症状性未破裂PICA动脉瘤。总体而言，11例患者接受了血管内治疗（弹簧圈栓塞），39例患者接受了动脉瘤的显微手术夹闭/包裹术。出院时，显微手术组患者的改良Rankin量表评分（2.3）相比血管内治疗组有更好的趋势，尽管未达到显著差异（3.0）（p = 0.20）。血管内治疗组的长期评分（1.6）也与显微手术组（1.9）相当（p = 0.55）。结论 虽然血管内治疗患者的早期结果似乎更好，但在短期和长期随访中，显微手术和血管内治疗组之间的结果在统计学上没有显著差异。
