Effect of different surgical options for posterior inferior cerebellar artery aneurysms

Abstract

Objective To explore the clinical effect of various surgical operations on the treatment of posterior inferior cerebellar aneurysm. Methods The clinical data of 36 patients with a total of 36 posterior inferior cerebellar aneurysms admitted to Department of Neurosurgery, Weihai Central Hospital from October 2014 to May 2017 were retrospectively analyzed. Among all 36 patients, 22 underwent transcatheter embolization, 9 underwent aneurysm clipping using craniotomy, and the remaining 5 underwent cerebral artery bypass surgery combined with transcatheter embolization. The treatment outcome was evaluated using Glasgow outcome scale(GOS) at discharge and modified Rankin scale (mRS) at follow-up. Imaging outcome was evaluated by digital subtraction angiography (DSA) or CT angiography (CTA). Results Of the 22 patients undergoing transcatheter embolization, 21 were completely embolized. Aneurysms in 8 of the 9 patients were successfully clipped. Successful vascular anastomosis and complete embolization were achieved in 5 patients undergoing cerebral artery bypass surgery combined with transcatheter embolization. Among the 36 patients, 9 cases developed non-newly developed postoperative neurological deficits and 1 died. Thirty-five patients were discharged with GOS grade Ⅴ in 18 cases, Ⅳ in 14 cases and Ⅲ in 3 cases. Thirty-five cases were reexamined by CTA or DSA at 2 weeks post operation, which indicated disappearance of aneurysm. At follow-up of 3 months to 1 year post operation, 3 cases(8.6%) of aneurysm recurrence were reported which had undergone interventional embolization, and the rest of 32 patients had no recurrence. Thirty-five patients were followed up for 1 year. The mRS score was 0-1 in 21 cases, 2 in 8, 3 in 3, 4 in 1 and 5 in 1 case. The rate of good outcome were 85.3% (29/34) and there was 1 patient lost to follow-up. Conclusions According to the specific condition, interventional embolization, craniotomy of aneurysm clipping, or cerebral artery bypass surgery combined with transcatheter embolization could be performed to treat the posterior inferior cerebellar aneurysm, which might lead to relatively good clinical outcome with low incidence of aneurysm recurrence. Key words: Incranial aneurysm; Embolization, therapeutic; Microsurgery; Treatment outcome; Inferior cerebellar artery