REVIEW   

Journal of Neurosurgical Sciences 2023 October;67(5):638-52

DOI: 10.23736/S0390-5616.22.05710-1

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Microsurgical and endovascular treatment of posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis

Giancarlo SAAL-ZAPATA ¹ ✉, Aaron RODRIGUEZ-CALIENES ², Marco MALAGA ³, Victor VELASQUEZ-RIMACHI ^{2, 3}, Cristian MORAN ^{3, 4}, Diego BUSTAMANTE-PAYTAN ⁵, Niels PACHECO-BARRIOS ^{3, 6}, Kevin PACHECO-BARRIOS ^{7, 8}, Carlos ALVA-DIAZ ², Melanie WALKER ⁹

¹ Section of Endovascular Neurosurgery, Department of Neurosurgery, Guillermo Almenara Irigoyen-EsSalud National Hospital, Lima, Peru; ² Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú; ³ Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru; ⁴ Scientific University of the South, Lima, Peru; ⁵ Research Unit in Bibliometrics, San Ignacio de Loyola University, Lima, Peru; ⁵ Faculty of Human Medicine, San Martin de Porres University, Lima, Peru; ⁶ Alberto Hurtado Faculty of Medicine, Cayetano Heredia Peruvian University, Lima, Peru; ⁷ Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA; ⁸ Research Unit for the Generation and Synthesis of Health Evidence, San Ignacio de Loyola University, Lima, Perú; ⁹ Department of Neurosurgery, University of Washington, Seattle, WA, USA

INTRODUCTION: Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic considerations may confer additional procedural risk, and as a result there is currently no consensus as to whether a surgical or endovascular approach offers greater safety and efficacy for patients.
EVIDENCE ACQUISITION: We systematically examined peer-reviewed literature describing PICA aneurysm treatment planning from January 2000 to May 2021 using the PRISMA methodology. A meta-analysis of proportions was performed. Certainty of the evidence was assessed using the GRADE approach.
EVIDENCE SYNTHESIS: Fifty-eight studies including 1673 PICA aneurysms were analyzed. Overall treatment occlusion rate was 97% (95% confidence interval [CI]: 93-100%) for surgery and 85% (95% CI: 78-92%) for endovascular therapy. The recurrence rate was 6% in the endovascular group and 1% for surgery. Overall morbidity and mortality were 16% and 7%, respectively. Intraoperative complications occurred in 9% of the surgical patients.
CONCLUSIONS: Despite a large body of literature, analysis indicates that 62% of studies had moderate or serious risk of bias, suggesting very-low certainty results. Therefore, treatment via either approach should be determined on a case-by-case basis and according to institutional experience.

KEY WORDS: Aneurysm; Endovascular procedures; Microsurgery