Endovascular surgery for proximal posterior inferior cerebellar artery aneurysms: an analysis of Glasgow Outcome Score by Hunt-Hess grades.
OBJECTIVE
Proximal posterior inferior cerebellar artery (PICA) aneurysms represent a subset of posterior circulation aneurysms that can be routinely treated with either clipping or coiling. The literature contains limited numbers of patients with proximal PICA aneurysms treated with endovascular surgery. We report our experience with endovascular surgery of proximal PICA aneurysms with emphasis on patients with poor Hunt-Hess grades.


METHODS
We reviewed 31 consecutive patients with proximal PICA aneurysms who were treated with endovascular surgery. The following data were analyzed: age, sex, size of aneurysm, Hunt-Hess grade at presentation, Fisher grade at presentation, angiographic result after embolization, complications, number of days hospitalized, duration of follow-up, angiographic follow-up results, and Glasgow Outcome Score at follow-up.


RESULTS
Excellent angiographic occlusion was achieved in 30 of 31 (97%) patients. Clinical follow-up with Glasgow Outcome Score was performed on every patient an average of 10 months later. Twenty-one of 31 (68%) patients had good outcomes (Glasgow Outcome Score I or II) at follow-up. Of the patients who presented with a favorable clinical grade (Hunt-Hess 0-III), 13 of 15 (87%) had good outcomes at follow-up. Of the patients who presented with a poor clinical grade (Hunt-Hess Grade IV or higher), 8 of 16 (50%) had good outcomes at follow-up.


CONCLUSIONS
This series demonstrates the safety and efficacy of endovascular surgery for proximal PICA aneurysms. Many patients with poor Hunt-Hess grades from ruptured PICA aneurysms ultimately had a good outcome. This could be secondary to early, aggressive treatment of hydrocephalus and the minimally invasive nature of the endovascular approach.
Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee, USA. robert.mericle@vanderbilt.edu
Robert A
RA
Mericle
Adam S
AS
Reig
Matthew V
MV
Burry
Eric
E
Eskioglu
Christopher S
CS
Firment
Swadeshmukul
S
Santra
D000328:Adult; D000368:Aged; D002531:Cerebellum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery