title: Vertebral artery-posterior inferior cerebellar artery convergence aneurysms treated by endovascular or surgical treatment: Mid- and long-term outcome.
abstract: BACKGROUND
  Management of vertebral artery-posterior inferior cerebellar artery convergence (VA-PICA) saccular aneurysms requires a specialized neurovascular team. The objective is to preserve the functional outcome while performing a complete and reliable long-term exclusion of the aneurysm.
  
  
  OBJECTIVE
  The aim of our study was to evaluate the outcome of patients with VA-PICA saccular aneurysms after treatment.
  
  
  METHODS
  This was a retrospective series of 21 consecutive patients with a VA-PICA saccular aneurysm treated between 2000 and 2012 at our institution. Treatment option (endovascular or microsurgical) was decided for each patient following a multidisciplinary discussion.
  
  
  RESULTS
  Twenty-one patients were treated for a VA-PICA saccular aneurysm including 16 for a ruptured aneurysm and 5 for an asymptomatic aneurysm. Among all patients, 11 underwent endovascular treatment and 10 had microsurgical treatment. Our results showed a major aneurysm recurrence after endovascular treatment in 3 patients that required a further endovascular treatment in 2 cases. These 3 major recurrences occurred after treatment of a ruptured aneurysm when the initial angiography demonstrated the origin of the PICA at the neck of the aneurysm. After microsurgery, angiography showed a remnant neck in 2 patients including 1 treated by further endovascular procedure.
  
  
  CONCLUSIONS
  VA-PICA aneurysms are rare and require multidisciplinary management. Microsurgical treatment should be discussed when the PICA originates from the aneurysmal neck, particularly in patients with a ruptured small aneurysm, in order to obtain a reliable and long-term exclusion of the aneurysm.
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue E.-Laine, 59037 Lille cedex, France. Electronic address: rabihdoc@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Aboukaïs
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue E.-Laine, 59037 Lille cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Department of Neuroradiology, Lille university Hospital, rue E.-Laine, 59037 Lille cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Boustia
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue E.-Laine, 59037 Lille cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Bourgeois
authors.affiliation: Department of Neuroradiology, Lille university Hospital, rue E.-Laine, 59037 Lille cedex, France.
authors.forename: X
authors.initials: X
authors.lastname: Leclerc
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue E.-Laine, 59037 Lille cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lejeune
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000601:surgery / Q000628:therapy*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014854:Lateral Medullary Syndrome / Q000209:etiology; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Aneurysm; Anévrisme; Endovasculaire; Endovascular; Microchirurgie; Microsurgery; PICA