Korean J Radiol.  2008 Oct;9(5):396-400. 10.3348/kjr.2008.9.5.396.

The Endovascular Management of Saccular Posterior Inferior Cerebellar Artery Aneurysms

• Song HH
• Won YD
• Kim YJ
• Kim BS

• KMID: 1385396
• DOI: http://doi.org/10.3348/kjr.2008.9.5.396

Abstract

OBJECTIVE
The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. MATERIALS AND METHODS: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. RESULTS: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedure-related morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). CONCLUSION: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective.

Keyword

Aneurysm; Posterior inferior cerebellar artery; Endovascular treatment

MeSH Terms

Adult
Aged
Aneurysm, Ruptured/radiography/*therapy
Cerebellum/blood supply/*radiography
Cerebral Angiography
Embolization, Therapeutic/*methods
Female
Humans
Incidental Findings
Intracranial Aneurysm/radiography/*therapy
Male
Middle Aged
Retrospective Studies
Subarachnoid Hemorrhage/radiography/*therapy
Treatment Outcome

Figure

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  Fig. 1 Complete packing of aneurysm.A. Oblique projection of right vertebral digital subtraction angiography displaying small aneurysm at anterior medullary segment of posterior inferior cerebellar artery and microcatheter tip within aneurysm.B. Complete packing of aneurysm was achieved with preservation of posterior inferior cerebellar artery.

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  Fig. 2 Vertebral artery occlusion for aneurysm management.A. Sagittal T1-weighted MR image shows incidental aneurysm proximal to right lateral portion of medulla.B. Right vertebral digital subtraction angiography shows saccular aneurysm at lateral medullary segment of posterior inferior cerebellar artery.C. Left vertebral injection obtained immediately after proximal occlusion of right vertebral artery, in vicinity of posterior inferior cerebellar artery with detachable balloon reveals opacified right vertebral artery and posterior inferior cerebellar artery from left vertebral artery.D. Follow-up digital subtraction angiography obtained 10 months after treatment shows slight decrease in size of aneurysm.E. Follow-up digital subtraction angiography 14 months after treatment reveals complete thrombosis of posterior inferior cerebellar artery and aneurysm.

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