title: Posterior inferior cerebellar artery aneurysms: operative strategies based on a surgical series of 27 patients.
abstract: OBJECTIVE
  Posterior inferior cerebellar artery (PICA) aneurysms are uncommon. The natural history and management of these aneurysms remains poorly understood. Surgical treatment of PICA aneurysms is challenging in view of their close neurovascular relationship.
  
  
  METHODS
  Data relating to clinical presentation, radiological findings, operative approaches and outcomes were analyzed in 27 consecutive patients surgically treated for PICA aneurysms in a single hospital between January 1991 and December 2010.
  
  
  RESULTS
  Headache was the most common presentation (100%) followed by gait ataxia (14.8%) and lower cranial nerve dysfunction (7.4%). SAH was seen in 20 patients, intraventricular hemorrhage in 22 patients, and 3 had evidence of intracerebellar hematoma. Eighteen aneurysms were located proximally and 9 were located distally. The 25 saccular and 2 fusi-saccular aneurysms were secured by direct clipping (24 cases) or aneurysmorrhaphy (3 cases) using a far-lateral suboccipital (without condylar resection) or midline/ paramedian suboccipital approach. Overall outcome at the time of hospital discharge was excellent or good in 88.9% of the patients.
  
  
  CONCLUSIONS
  PICA aneurysms, by virtue of their rarity and strategic location pose a unique technical challenge. Depending on the PICA segment affected, variations in the surgical corridor and clipping strategy were major contributors to good outcomes.
authors.affiliation: Sree Chitra Tirunal Institute for Medical Sciences & Technology, Department of Neurosurgery, Trivandrum, India.
authors.forename: Gopalakrishnan Chittur
authors.initials: GC
authors.lastname: Viswanathan
authors.forename: Girish
authors.initials: G
authors.lastname: Menon
authors.forename: Suresh
authors.initials: S
authors.lastname: Nair
authors.forename: Mathew
authors.initials: M
authors.lastname: Abraham
mesh_terms: D000328:Adult; D000368:Aged; D002531:Cerebellum / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome