Abstract
Many patients with ruptured saccular aneurysms at the vertebral artery (VA)-posterior inferior cerebellar artery (PICA) junction generally have a good prognosis after surgical intervention. Morbidity, which is mainly due to postoperative cranial nerve dysfunction and cerebral vasospasm, however, is not so favorable, because of VA-PICA aneurysms exist adjacent to cranial nerves and brain stem.
We analyzed the prognostic factors, that is, operative complications and cerebral vasospasm in 23 patients with VA-PICA aneurysms. All patients had suffered from subarachnoid hemorrhage (SAH). Nineteen patients underwent direct aneurysmal surgery. Postoperative cranial nerve dysfunction appeared in 8 patients. Five of them ameliorated within a week. Postoperative cranial dysfunction was observed in patients with an aneurysm over 10 mm from the foramen magnum and was not correlated with distance from the midline in this study. We also analyzed the anatomical types of aneurysmal location. As a result, we concluded that postoperative cranial nerve dysfunction depended on the positional relationships of the cranial nerves and aneurysm, rather than the distance from each landmark to aneurysmal neck. Premature aneurysmal rupture during surgery greatly accelerated prolonged postoperative cranial nerve dysfunction.
Three patients demonstrated symptomatic cerebral vasospasm in the present series. CT scans manifested cerebral infarction in the territory of the middle cerebral artery due to vasospasm in 2 cases.
Only 1 of the 3 cases underwent direct aneurysmal surgery in the acute stage. Patients with ruptured VA-PICA aneurysms should require prophylactic therapy for cerebral vasospasm following surgery during the acute phase as in the anterior circulation aneurysms.
