title: Treatment Strategy for Isolated Posterior Inferior Cerebellar Artery Dissection.
abstract: OBJECTIVE
  Isolated dissections that develop on the posterior inferior cerebellar artery (PICA) require intensive treatment because of their potential fatality. However, because of the rarity of these dissections, the optimal treatment has not yet been established.
  
  
  METHODS
  We retrospectively reviewed the clinical records of all patients who underwent any PICA dissection treatment in our institute over the last 4 years. Ten patients were enrolled, including 7 patients with subarachnoid hemorrhage (SAH) and 3 with PICA territory infarction. Dissection was seen at the proximal portion in 8 patients, whereas the remaining 2 patients showed distal PICA dissecting aneurysms.
  
  
  RESULTS
  Among the 7 patients with hemorrhage, 5 were actively treated (trapping and bypass, 2 patients; surgical clipping, 1 patient; coil embolization, 2 patients). Conservative management was performed in the other 2 patients. Among the 3 patients with infarction, 2 received conservative treatment. Endovascular treatment was performed in 1 patient, who showed rapid progression, aneurysm formation, and conversion to massive SAH within 10 days after the initial attack. Although 7 patients showed relatively good outcomes (modified Rankin Scale score, ≤2) after 30 days of follow-up, 1 patient had a final modified Rankin Scale score of 3. In addition, the other 2 patients (1 in each group) died as a result of major SAH.
  
  
  CONCLUSIONS
  Given the dynamic clinical course and potential fatality of PICA dissection, meticulous evaluation, intensive treatment with a diverse range of modalities, and proper follow-up are required for patients with PICA dissection to achieve favorable outcomes.
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea.
authors.forename: Yeongu
authors.initials: Y
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea.
authors.forename: Jiwook
authors.initials: J
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea.
authors.forename: Seok Keun
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea.
authors.forename: Eui Jong
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea. Electronic address: nooname79@gmail.com.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000601:surgery; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
keywords: Coil embolization; Isolated PICA dissection; OA-PICA bypass surgery; PICA dissecting aneurysm; Trapping