Endovascularly or surgically treated vertebral artery and posterior inferior cerebellar artery aneurysms: clinical analysis and results

Zentralbl Neurochir. 2005 Feb;66(1):9-16. doi: 10.1055/s-2004-836224.


Objective: To describe the clinical results in patients with aneurysms of the vertebral artery and posterior inferior cerebellar artery complex (VA-PICA) treated by endovascular embolization or surgically in cases considered untreatable by endovascular methods.

Patients and methods: During a 5-year-period a total of 28 patients with a VA-PICA complex aneurysm out of 600 patients received definitive treatment, 19 patients by endovascular embolization and 9 patients surgically. Mean age was 54 years (range 9-75 years). Clinical data, intraoperative observations and procedural complications were evaluated. The mean follow-up was 9 months.

Results: Hunt-Hess (HH) grades were HH 0-II in 10 patients (35.7 %), HH III in 6 patients (21.4 %) and HH IV + V in 12 patients (42.9 %). Aneurysm size ranged from 2 to 40 mm (mean size 5.5 mm). Aneurysm configuration was saccular 18, fusiform 7 and multilobed 3. Complete occlusion was achieved in all cases. Overall 67.9 % (n = 19) showed a favorable outcome (Glasgow Outcome Score IV + V). Overall procedure-related rate for permanent morbidity and mortality was 3.6 % (n = 1) and 3.6 % (n = 1), respectively. Predictive factors of clinical outcome were the initial clinical HH grade and the Fisher grade.

Conclusion: Endovascular embolization is an effective method for the treatment of VA-PICA aneurysms. Surgical clipping is still an alternative and should be considered for "uncoilable" lesions. Outcomes showed a close correlation to the initial clinical state and were not dependent on the treatment modality.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cerebellum / blood supply
  • Cerebral Angiography
  • Cerebral Arteries / pathology
  • Cerebral Arteries / surgery*
  • Child
  • Embolization, Therapeutic* / adverse effects
  • Female
  • Glasgow Outcome Scale
  • Humans
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / surgery*
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Neurosurgical Procedures* / adverse effects
  • Retrospective Studies
  • Treatment Outcome
  • Vertebral Artery / pathology
  • Vertebral Artery / surgery*