Abstract
We reviewed the surgical outcomes and operative techniques for 41 saccular vertebral artery aneurysms originating at the posterior inferior cerebellar artery (VA-PICA aneurysms) in 41 patients operated between 1995 and 2003. There were 29 ruptured and 12 unruptured aneurysms. All the aneurysms were clipped satisfactorily with the exception of one case that showed a small residual neck postoperatively.
Using the Glasgow Outcome Scale, surgical outcomes were good recovery in 75.6%; moderate disability, 4.9%; severe disability, 4.9%; persistent vegetative state, 4.9%; and death, 9.8%. Poor clinical outcomes stemmed from the poor preoperative neurological status. Surgery for unruptured aneurysms and delayed surgery for ruptured aneurysms were uncomplicated, while early surgery resulted in transient lower cranial nerve palsy in 3 cases. These transient deficits were tolerable, and patients fully recovered within one month. Technical prerequisites for safe surgery include removing the bone lateral to the foramen magnum as laterally as possible, which enables the surgeon to work without retraction of the cerebellum and brainstem. Elective surgery was associated with lower complication rates than early surgery, but the risk of rebleeding was substantial during the waiting period.
In view of these results, we recommend surgical clipping for VA-PICA aneurysms whenever possible, and early surgery for ruptured ones.
