title: Endovascularly or surgically treated vertebral artery and posterior inferior cerebellar artery aneurysms: clinical analysis and results.
abstract: OBJECTIVE
  To describe the clinical results in patients with aneurysms of the vertebral artery and posterior inferior cerebellar artery complex (VA-PICA) treated by endovascular embolization or surgically in cases considered untreatable by endovascular methods.
  
  
  METHODS
  During a 5-year-period a total of 28 patients with a VA-PICA complex aneurysm out of 600 patients received definitive treatment, 19 patients by endovascular embolization and 9 patients surgically. Mean age was 54 years (range 9-75 years). Clinical data, intraoperative observations and procedural complications were evaluated. The mean follow-up was 9 months.
  
  
  RESULTS
  Hunt-Hess (HH) grades were HH 0-II in 10 patients (35.7 %), HH III in 6 patients (21.4 %) and HH IV + V in 12 patients (42.9 %). Aneurysm size ranged from 2 to 40 mm (mean size 5.5 mm). Aneurysm configuration was saccular 18, fusiform 7 and multilobed 3. Complete occlusion was achieved in all cases. Overall 67.9 % (n = 19) showed a favorable outcome (Glasgow Outcome Score IV + V). Overall procedure-related rate for permanent morbidity and mortality was 3.6 % (n = 1) and 3.6 % (n = 1), respectively. Predictive factors of clinical outcome were the initial clinical HH grade and the Fisher grade.
  
  
  CONCLUSIONS
  Endovascular embolization is an effective method for the treatment of VA-PICA aneurysms. Surgical clipping is still an alternative and should be considered for "uncoilable" lesions. Outcomes showed a close correlation to the initial clinical state and were not dependent on the treatment modality.
authors.affiliation: Department of Neurosurgery, University of Essen, Germany. sandalcioglu@uni-essen.de
authors.forename: I E
authors.initials: IE
authors.lastname: Sandalcioglu
authors.forename: I
authors.initials: I
authors.lastname: Wanke
authors.forename: B
authors.initials: B
authors.lastname: Schoch
authors.forename: T
authors.initials: T
authors.lastname: Gasser
authors.forename: J P
authors.initials: JP
authors.lastname: Regel
authors.forename: A
authors.initials: A
authors.lastname: Doerfler
authors.forename: M
authors.initials: M
authors.lastname: Forsting
authors.forename: D
authors.initials: D
authors.lastname: Stolke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002531:Cerebellum / Q000098:blood supply; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery*; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000473:pathology / Q000601:surgery*