title: [Therapeutic strategy for isolated dissecting aneurysms of the posterior inferior cerebellar artery: report of three cases and review of literature].
abstract: Dissecting aneurysm of the posterior inferior cerebellar artery (PICA) is a relatively rare disease and its treatment has not been well established. The authors analyzed the clinical and anatomical features of 38 reported lesions and three of our cases to clarify the "best therapeutic modality". The average age was 45.0 years old and 27 patients were male. Left-sided predominance (26 cases) was noted. As to the mode of onset, 23 cases were subarachnoid hemorrhage, 16 were ischemia, and 6 were Wallenberg's syndrome. Anatomically, the sites of dissection were located in the proximal segment of PICA in 31 lesions (75.6%). Review of the cases show that 30 (75%) patients underwent surgical therapy, and 7 (17.5%) patients underwent endovascular treatment. Twenty six patients who took surgical therapy and 5 patients who took endovascular treatment had excellent or good outcome. The critical point in therapeutic procedure is the preservation of perforating branches arising from PICA, therefore surgical trapping with the revascularization of PICA (usually extracranial-PICA anastomosis), in which these tiny branches are secured under microscopic manipulation, has the advantage in principle.
authors.affiliation: Department of Neurosurgery, National Cardiovascular Center, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Seyama
authors.forename: Takeo
authors.initials: T
authors.lastname: Nishida
authors.forename: Munetaka
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Hisae
authors.initials: H
authors.lastname: Mori
authors.forename: Tetsu
authors.initials: T
authors.lastname: Satow
authors.forename: Jun
authors.initials: J
authors.lastname: Yamada
authors.forename: Norio
authors.initials: N
authors.lastname: Nakajima
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.forename: Kenichi
authors.initials: K
authors.lastname: Murao
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000601:surgery*; D002531:Cerebellum / Q000098:blood supply*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures / Q000379:methods