title: Management of posterior inferior cerebellar artery aneurysms: What factors play the most important role in outcome?
abstract: Posterior inferior cerebellar artery (PICA) aneurysms are an uncommon, heterogeneous group of aneurysms with poorer clinical outcomes compared to other intracranial aneurysms. We performed a multicenter retrospective study to analyze the outcome in a large series of patients treated with modern microsurgical and endovascular techniques.
  
  
  
  Records of 94 patients treated for PICA aneurysms between 2000 and 2015 at three large tertiary referral centers were retrospectively reviewed.
  
  
  
  Eighty-three patients met inclusion criteria and of these, two died before treatment, leaving 81 treated patients (43 underwent endovascular and 38 surgical treatment). Among patients treated endovascularly, procedure-related complications occurred in four cases (11.8%). Six patients (19.4%) suffered from complications directly associated with surgery. Recurrences occurred in 0% of surgical and in 16.3% of endovascularly treated patients, requiring treatment. Patients with unruptured asymptomatic aneurysms had good outcomes. In the group of 67 ruptured aneurysms, 16 endovascularly (47.1%) and 15 surgically (48.4%) treated patients had modified Rankin scale (mRS) scores of 3-6. Of patients in poor neurological condition (Hunt & Hess (H&H) IV-V at admission), 84.6% suffered a poor clinical outcome. Fifty percent of patients with distal and 31.9% patients with proximal ruptured PICA aneurysms suffered a poor neurological outcome.
  
  
  
  This study of PICA aneurysms demonstrates that results of both treatment modalities are comparable. However, endovascular treatment is associated with higher risks of recurrence, requiring additional treatment. Outcomes were mostly impacted by clinical state at admission.
authors.affiliation: Neurosurgery Department, J.E. Purkynje University, Masaryk Hospital, Sociální péče 3316/12A, 400 11, Ústí nad Labem, Czech Republic. alena.sejkorova@gmail.com.|Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA. alena.sejkorova@gmail.com.
authors.forename: Alena
authors.initials: A
authors.lastname: Sejkorová
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Ondra
authors.initials: O
authors.lastname: Petr
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Miriam
authors.initials: M
authors.lastname: Mulino
authors.affiliation: Department of Mathematics, Faculty of Science, J.E. Purkynje University, Ústi nad Labem, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Cihlář
authors.affiliation: Neurosurgery Department, J.E. Purkynje University, Masaryk Hospital, Sociální péče 3316/12A, 400 11, Ústí nad Labem, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Aleš
authors.initials: A
authors.lastname: Hejčl
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Claudius
authors.initials: C
authors.lastname: Thomé
authors.affiliation: Neurosurgery Department, J.E. Purkynje University, Masaryk Hospital, Sociální péče 3316/12A, 400 11, Ústí nad Labem, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Sameš
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery* / Q000628:therapy; D002536:Cerebral Arteries / Q000473:pathology; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
keywords: Aneurysm; Clip occlusion; Coil embolization; Posterior inferior cerebellar artery; Subarachnoid hemorrhage