Direct Surgery for Dissecting Vertebral Aneurysms Involving PICA

Abstract

We discuss options, techniques, pitfalls, and risk and benefits of surgical treatments for dissecting vertebral aneurysms involving the posterior inferior cerebellar artery (PICA). Our discussion is based on recent experience of 12 cases over a 5-year period of direct trapping for ruptured aneurysms with/without PICA involvement in the acute stage. Three aneurysms involving the PICA were treated in the first stage by direct trapping and PICA revascularization, of which 1 was a side-to-side VA-PICA bypass. The other 2 were OA-PICA bypasses.
Five of 6 patients (89%) of SAH Grade 1 or 2 had an excellent outcome (GR). Cranial nerve injury or ischemic complication of perforators might occur in a few cases, and the outcome could depend on SAH grade.
We conclude that direct trapping and simple revascularization for the PICA may be the best treatment for a dissecting vertebral artery involving the PICA.