Multidisciplinary Treatments of True Posterior Inferior Cerebellar Artery Aneurysms: Single-Center Retrospective Study and Treatment Algorithm

Introduction The effectiveness and reliability of flow-diverter stents, which are commonly used in aneurysms of the anterior circulation, have been demonstrated previously. However, the use of these devices is associated with higher rates of perforator and branch ischemia following the treatment of aneurysms of the posterior circulation. Methods This work involved a single-center; retrospective study reviewing eight patients who had aneurysms related to the posterior inferior cerebellar artery (PICA) and who were treated with flow-diverter stents from September 2013 to May 2017. Results The mean aneurysm diameter was 7.6 mm (range, 5 to 11 mm). The types of aneurysm included five aneurysms that were saccular, two that were fusiform, and one that was dissecting. All saccular aneurysms in the neck involved the PICA origin, and one dissecting aneurysm was localized in the proximal part of the PICA. Procedural success was 100% (8/8), and there were no ischemic complications. One patient with subarachnoid hemorrhage died because of rebleeding (modified Rankin Scale (mRS), 6). Other than this patient all of the patients’ mRS scores were zero at discharge and at the clinical follow-up period (mean, 2.5 years). All of the aneurysms were completely occluded according to the latest angiographic controls (mean follow-up period of 19.5 months). Conclusions Treatment of PICA aneurysms with flow-diverter stents showed positive results with a high rate of technical success and low complication and mortality rates. The use of flow-diverter stents in the treatment of PICA aneurysms should be considered a safe and effective endovascular treatment option.

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Surgical Management of Ruptured Posterior Circulation Aneurysms – A Single Center Experience

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1597821 ◽

2017 ◽

Vol 36 (01) ◽

pp. 14-20 ◽

Cited By ~ 1

Author(s):

João Silva ◽

Joana Machado ◽

Ana Machado ◽

Célia Pinheiro ◽

Joaquim Rei ◽

...

Keyword(s):

Medical Records ◽

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Single Center ◽

Ruptured Aneurysms ◽

Single Center Experience ◽

Cerebellar Artery ◽

Posterior Circulation Aneurysm ◽

Posterior Circulation Aneurysms ◽

Early Surgical Treatment

Objective The treatment of ruptured aneurysms of the posterior circulation is a controversy in neurosurgery. The aim of this work is to describe the experience and results of the early surgical treatment of this pathology at Centro Hospitalar do Porto. Method We retrospectively analyzed the medical records of all patients aged over 18 who, in the period between 1999–2013, were admitted to our center with the diagnosis of ruptured saccular posterior circulation aneurysm. The patients were clinically staged at admission using the Hunt & Hess (H&H) scale. The modified Glasgow Outcome Scale (mGOS) was used to assess the outcome at discharge and after 6 months. Results Between 1999–2013, 59 patients underwent surgery for ruptured posterior circulation aneurysms. Eighty percent of the patients were female, and their average age was 58.7 years. Posterior-inferior cerebellar artery aneurysms accounted for 49.2% of surgeries, while basilar aneurysms accounted for 28.8%. Upon admission, 86.4% of patients were classified as H&H1–3, and 13.6% as H&H4–5. The outcomes at discharge and at 6 months were as follows: at discharge, mGOS1 in 5.1%, mGOS2–3 in 18.6%, and mGOS4–5 in 76.3%; at 6 months, mGOS1 in 10.2%, mGOS2–3 in 10.2%, and mGOS4–5 in 79.6%. There was a statistically significant correlation between basilar aneurysms and worse outcomes (p = 0.011). No correlation was found between the values of the H&H scale upon admission and outcome. Conclusions The functional outcome of our group of patients is mainly in line with what is described in other series from the literature. However, there is a trend toward lower mortality but higher morbidity rates.

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Clinical and Radiological Profile of Patients Presenting With Isolated Acute Cerebellar Infarct: A Single Tertiary Center 3 Years Retrospective Study From Central Stroke Unit, Muscat, Oman

Journal of Stroke Medicine ◽

10.1177/25166085211038210 ◽

2021 ◽

pp. 251660852110382

Author(s):

Amal M. Al Hashmi ◽

Sanjith Aaron ◽

Ahmed Al Sinani ◽

Divyan Pancharatnam

Keyword(s):

Retrospective Study ◽

Stroke Unit ◽

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Large Artery ◽

Presenting Symptoms ◽

Cerebellar Artery ◽

Tertiary Center ◽

Cerebellar Infarct ◽

Prompt Diagnosis

Introduction: Cerebellar infarct can present with a broad spectrum of clinical and radiographic features. Recognizing this spectrum is extremely important for prompt diagnosis and to avoid morbidity and mortality. Objective: To identify the clinical and radiological profile of patients presenting with isolated acute cerebellar infarct. Methods: Retrospective study carried out at the central stroke unit of Oman over 27 months. Only patients with isolated acute cerebellar infarct confirmed by either magnetic resonance imaging or computerized tomography (CT) were included in this study. A total of 76 cases were identified. Results: Isolated cerebellar infarct constituted 4% of all acute ischemic strokes treated during the study period. Gait imbalance and difficulty in articulating were seen in 30/48 (63%) and 12/48 patients (25%), respectively. Ataxia and nystagmus were the main signs seen 30/48 (63%) and 10/48 (21%), respectively. Large artery atherosclerosis comprised 15/48 (31%), of the underlying etiology. Normal and complete posterior circulation was seen only in 6/36 (17%). Unilateral or bilateral hypoplasia or absence of posterior communicating artery (PCOM) were the commonest variants seen in our patients. The cerebellar arterial territory most commonly involved in this series was posterior inferior cerebellar artery (58%). Infarct extension was seen in 10/48 patients (21%), with 4/10 (40%) having bilateral absent PCOM followed by 2/10 (20%) normal posterior circulation. Conclusions: Acute gait imbalance and difficulty in articulating can be the only presenting symptoms in isolated cerebellar infarct. Plain CT in the acute phase can miss such infarcts in up to 46% cases. The majority of cases had an incomplete anatomy of the posterior circulation.

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