![]() Of the remaining 102 aneurysms, 77% were ruptured and 64% were treated microsurgically. Descriptive, univariate, and multivariate statistical analyses were performed.Ī total of 113 PICA aneurysms were identified 11 did not undergo treatment. Patients were categorized on the basis of their aneurysm's anatomical location, presentation status, treatment modality, and subsequent complications. To assess treatment outcomes for PICA aneurysms based on mode of management and anatomical location.Ī prospectively maintained database was queried for PICA aneurysms treated from 2000 through 2012. Few data exist to compare the 2 treatment approaches for aneurysms in this location. The small caliber of the PICA and the broad neck often associated with these aneurysms also create challenges in preserving this artery during treatment. PICA = posterior inferior cerebellar artery VA = vertebral artery dissecting aneurysm far-lateral craniotomy posterior inferior cerebellar artery reimplantation vascular disorders vertebral artery.The vicinity of brainstem and cranial nerves as well as the limited operative working space make clip ligation of posterior inferior cerebellar artery (PICA) aneurysms challenging. The final decision to reimplant the PICA depends on careful inspection of perforator anatomy that is not visible preoperatively on angiography, as well as an assessment of technical difficulty intraoperatively. PICA reimplantation is a revascularization option for dissecting VA aneurysms incorporating the PICA origin that are < 13 mm in length, and for nonsaccular proximal PICA aneurysms that are < 6 mm in diameter. CONCLUSIONS The buffer lengths measured in this study describe the limitations of PICA reimplantation as a revascularization procedure for nonsaccular aneurysms in this location. The PICA was less maneuverable when it was reimplanted across the VA, due to perforator branches of the PICA (P 3 segment). The mean buffer length with reimplantation along the VA axis was 13.43 ± 4.61 mm, and it was 6.97 ± 4.04 mm with reimplantation across the VA. No direct perforator was found on the P 1 segment. The most common perforating artery on the P 1 and P 2 segments was the short circumflex type. RESULTS The PICA was reimplanted in all surgical simulations. The buffer lengths provided by mobilization of the artery in each paradigm were measured and the anatomy of perforator branching on the proximal PICAs was analyzed. The PICA was mobilized and reimplanted onto the VA according to 2 different paradigms: 1) transposition along the axis of the VA (along-VA) to simulate a dissecting VA, and 2) transposition perpendicular to the axis of the VA (across-VA) to simulate a nonclippable, proximal PICA aneurysm. Twenty far-lateral approaches were performed. METHODS Ten cadaver heads (20 sides) were prepared for surgical simulation. The goal of this study was to define the surgical anatomy and buffer lengths specific to the proximal segment of the PICA related to 2 variations of PICA reimplantation: 1) reimplantation "along-VA" (simulating a dissecting VA aneurysm), and 2) reimplantation "across-VA" (simulating a nonclippable, proximal PICA aneurysm). However, the anatomy and limitations of this technique have not been studied. OBJECTIVE Reimplantation of the posterior inferior cerebellar artery (PICA) to the vertebral artery (VA) is a safe and effective bypass option after deliberate PICA sacrifice during the treatment of nonsaccular and dissecting aneurysms at this location. ![]()
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