title: Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis.
abstract: We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms.
  
  
  
  A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality.
  
  
  
  We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 % (95 % CI = 94.5-99.0 %) in the surgical group and 84.3 % (95 % CI = 73.8-92.6 %) in the endovascular group. Aneurysm recurrence occurred in 1.4 % (95 % CI = 0.3-3.3 %) after surgery and in 6.9 % (95 % CI = 3.6-10.9 %) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 % (95 % CI = 8.7-21.2 %) and 9.8 % (95 % CI = 5.8-14.8 %) after surgery and 15.1 % (95 % CI = 10.5-20.2 %) and 17.1 % (95 % CI = 11.5-23.7 %) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 % (95 % CI = 79.5-100 %) in the surgical group and 75.7 % (95 % CI = 45.4-97.1 %) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 % (95 % CI = 74.4-100 %) in the surgical series and 93.3 % (95 % CI = 82.7-99.5 %) in the endovascular group.
  
  
  
  Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. ondra.petr@yahoo.com.|Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. ondra.petr@yahoo.com.
authors.forename: Ondra
authors.identifier: 0000-0002-2258-1032
authors.initials: O
authors.lastname: Petr
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.|Neurosurgery Department, J. E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Sejkorová
authors.affiliation: Department of Neurosurgery of 1st Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Prague, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Bradáč
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D002536:Cerebral Arteries / Q000601:surgery; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D010243:Paralysis / Q000209:etiology*; D011183:Postoperative Complications; D020521:Stroke / Q000209:etiology*; D016896:Treatment Outcome
keywords: Aneurysm; Endovascular treatment; Meta-analysis; Microsurgery; PICA