![]() ![]() Twelve patients exhibited no focal abnormalities during the initial evaluation. Concomitant with their ictus, four patients had seizures and two had a cardiopulmonary arrest. This delay in referral skews our series toward patients who did relatively well after their initial hemorrhage, and prevents any conclusions regarding the natural history and preoperative mortality rate associated with such lesions.Īll patients presented with classic SAH symptoms: sudden severe headache (usually occipital) followed by an altered level of consciousness (19 cases), including lethargy or coma. One of these was initially operated on unsuccessfully elsewhere and was admitted 62 days after ictus, and the other was seen 1 year after subarachnoid hemorrhage (SAH). The mean time from ictus to referral was 8.2 days, with a range of several hours to 22 days, excluding two patients. ![]() All 21 patients were initially evaluated at other hospitals, and subsequently transferred to our institution. The average age of these patients was 52 years, with a range of 27 to 73 years, and there was a striking female predominance (16 patients). Clipping of the neck is the preferred treatment, but trapping is usually safe, if necessary.īetween 19, 21 cases of saccular PICA-vertebral and distal PICA aneurysms were operated on at the University of Florida (Table 1). More distal (retromedullary) PICA aneurysms are sometimes associated with another vascular anomaly (two cases in this series), and are best handled through a bilateral suboccipital craniectomy. Isolated clipping of the aneurysm neck is essential in this instance, as trapping may compromise vital perforating arteries of the brain stem. Aneurysms at the PICA-vertebral junction usually occur at least 1 cm above the foramen magnum level, arise distal to the PICA origin in the angle between the two vessels, and are best approached by a paramedian incision with the patient in the lateral recumbent position. The angiographic and surgical features of these lesions are determined by the course of the vertebral artery and PICA that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. Clinically significant vasospasm and aneurysm multiplicity occurred with approximately equal frequency as at other locations. The lack of specific focal deficits prevented an accurate pre-angiographic determination of aneurysm location in most instances. Most of these aneurysms occurred in females (16 of 21) and presented as classic subarachnoid hemorrhage. Twelve lesions arose from the left PICA, nine were right-sided, and all were small (less than 12.5 mm). Seventeen of these lesions originated from the PICA-vertebral junction, and four arose from distal PICA branching sites. The clinical and anatomical features of 21 surgically treated saccular aneurysms of the posterior inferior cerebellar artery (PICA) are analyzed. ![]()
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