caa a22 4500 445328924 CHVBK 20180317142731.0 cr unu---uuuuu 170323e20110101xx s 000 0 eng 10.1007/s10143-010-0296-z doi (NATIONALLICENCE)springer-10.1007/s10143-010-0296-z Clinical presentation and treatment of distal posterior inferior cerebellar artery aneurysms [Elektronische Daten] [Hiroshi Tokimura, Hitoshi Yamahata, Takashi Kamezawa, Kenichiro Tajitsu, Tetsuya Nagayama, Sei Sugata, Kosuke Takiguchi, Ayumi Taniguchi, Masaki Niiro, Kazuho Hirahara, Koji Takasaki, Tatsuki Oyoshi, Kazunori Arita] Aneurysms located at the distal portion of the posterior inferior cerebellar artery (PICA) are rare, and their clinical features are not fully understood. We report the clinical features and management of 30 distal PICA aneurysms in 28 patients treated during the past decade at Kagoshima University Hospital and affiliated hospitals. Our series includes 20 women and eight men. Of their 30 aneurysms, 24 were ruptured, and six were unruptured; there were 27 saccular and two fusiform aneurysms; one was dissecting. Their location was at the anterior-medullary (n = 4), lateral-medullary (n = 9), tonsillomedullary (n = 7), telovelotonsillar (n = 6), and cortical (n = 4) segment of the PICA. In 18 patients, angiographic features suggested hemodynamic stress including an absent contralateral PICA or ipsilateral anterior inferior cerebellar artery, termination of the vertebral artery (VA) at the PICA, and hyperplasia or occlusion of the contralateral VA. As three patients died before surgery, 27 aneurysms in 25 patients were surgically treated. Of these, 6 were unruptured aneurysms; 20 were clipped via midline or lateral suboccipital craniotomy, and 5 were embolized with Guglielmi coils; in one, the PICA flow was reconstructed by OA-PICA anastomosis, and in the other one, the PICA was resected. Of the 25 surgically treated patients, 22 (88%) had good outcomes. The predominant contributor to the development of distal PICA aneurysms is thought to be increased hemodynamic stress attributable to anomalies in the PICA and related posterior circulation. Both direct clipping and coil embolization yielded favorable outcomes in our series. However, considering the difficulties that may be encountered at direct clipping in the acute stage and the availability of advanced techniques and instrumentation, aneurysmal coiling is now the first option to address these aneurysms. Springer-Verlag, 2010 Posterior inferior cerebellar artery nationallicence Aneurysm nationallicence Clipping nationallicence Subarachnoid hemorrhage nationallicence Hemodynamic stress nationallicence Tokimura Hiroshi Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Yamahata Hitoshi Division of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan aut Kamezawa Takashi Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Tajitsu Kenichiro Division of Neurosurgery, Sendai Shimin Hospital, Satsumasendai, Japan aut Nagayama Tetsuya Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Sugata Sei Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Takiguchi Kosuke Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Taniguchi Ayumi Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Niiro Masaki Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Hirahara Kazuho Division of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan aut Takasaki Koji Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan aut Oyoshi Tatsuki Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Arita Kazunori Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut Neurosurgical Review Springer-Verlag 34/1(2011-01-01), 57-67 0344-5607 34:1<57 2011 34 10143 https://doi.org/10.1007/s10143-010-0296-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10143-010-0296-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tokimura Hiroshi Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Yamahata Hitoshi Division of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan aut NATIONALLICENCE 700 1- Kamezawa Takashi Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Tajitsu Kenichiro Division of Neurosurgery, Sendai Shimin Hospital, Satsumasendai, Japan aut NATIONALLICENCE 700 1- Nagayama Tetsuya Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Sugata Sei Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Takiguchi Kosuke Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Taniguchi Ayumi Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Niiro Masaki Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Hirahara Kazuho Division of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan aut NATIONALLICENCE 700 1- Takasaki Koji Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan aut NATIONALLICENCE 700 1- Oyoshi Tatsuki Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 700 1- Arita Kazunori Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan aut NATIONALLICENCE 773 0- Neurosurgical Review Springer-Verlag 34/1(2011-01-01), 57-67 0344-5607 34:1<57 2011 34 10143 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer