title: Multidisciplinary management for the treatment of proximal posterior inferior cerebellar artery aneurysms.
abstract: OBJECTIVE
  Aneurysms of the proximal posterior inferior cerebellar artery (PICA) are rare. The management of proximal PICA aneurysms is challenging with either surgical or endovascular treatment. We report our successful experience of treating PICA aneurysms with a multimodal approach.
  
  
  METHODS
  Of 2382 treated aneurysms, 22 aneurysms in 21 patients (male:female 8:13, mean age 48.9 years) were enrolled from March 1998 to December 2015. We treated the aneurysms with a multimodal approach and performed angiography to examine aneurysm regrowth at the 12 months follow-up. Clinical outcomes were evaluated based on the modified Rankin Score (mRS) at the time of discharge and 12 months postoperatively. The treatment modality was mainly dependent on the character of the aneurysms and the clinical presentation of the patients.
  
  
  RESULTS
  Microsurgery was performed in seven patients, which entailed proximal occlusion with distal revascularization in two and microsurgical clipping in five. Endovascular treatment was performed in 10 patients because of a serious medical condition, or vertebral artery (VA)/ or PICA tortuosity. Four were treated with coil embolization and six with stent or balloon-assisted coil embolization. Combined surgical and endovascular treatment was applied in four patients. They were treated with distal revascularization followed by occlusion with coils of the aneurysm-incorporated PICA. All patients achieved complete cure of the PICA aneurysms without complications except for one case of cerebrospinal fluid (CSF) leakage.
  
  
  CONCLUSIONS
  Endovascular and microvascular neurosurgeons should work closely in managing these challenging problems. Neurosurgeons should consider multimodal treatment in these cases including trapping after occipital artery (OA)-PICA bypass.
authors.affiliation: a Department of Neurosurgery , College of Medicine, Yonsei University, Gangnam Severance Hospital , Seoul , South Korea.
authors.forename: Kwang-Chun
authors.initials: KC
authors.lastname: Cho
authors.affiliation: a Department of Neurosurgery , College of Medicine, Yonsei University, Gangnam Severance Hospital , Seoul , South Korea.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
authors.affiliation: b Department of Radiology , College of Medicine, Yonsei University, Gangnam Severance Hospital , Seoul , South Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.affiliation: a Department of Neurosurgery , College of Medicine, Yonsei University, Gangnam Severance Hospital , Seoul , South Korea.
authors.forename: Jin Yang
authors.initials: JY
authors.lastname: Joo
authors.affiliation: a Department of Neurosurgery , College of Medicine, Yonsei University, Gangnam Severance Hospital , Seoul , South Korea.
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Hong
mesh_terms: D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Posterior inferior cerebellar artery; aneurysm; bypass; endovascular; subarachnoid hemorrhage