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Endovascular treatment of posterior inferior cerebellar artery trunk aneurysm

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Abstract

Background

The posterior inferior cerebellar artery (PICA) generally originates from the vertebral artery (VA) and is the most complex cerebellar artery. Aneurysms can occur at any site along the PICA trunk. Although most PICA aneurysms are located at the VA–PICA junction, a small proportion is located at the PICA trunk. Endovascular treatment (EVT) of aneurysms in the PICA trunk may be difficult and complex.

Methods

We performed a review to expound upon EVT of PICA trunk aneurysms.

Results

The PICA can be divided into five segments (p1–5); the p1–3 segments are proximal segments, and the p4–5 segments are distal segments. Most PICA trunk aneurysms are dissecting aneurysms. Sometimes, the PICA can give rise to flow-related aneurysms in association with cerebellar arteriovenous malformations. Most aneurysms of the PICA trunk require aggressive treatment, especially those that have ruptured. Currently, the EVT mainly includes selective coiling with/without stent assistance and parent artery occlusion. Recently, some new devices, such as flow diversion and Barricade and Kaneka ED coils, can be used to treat PICA trunk aneurysms. The risk of complications with EVT seems to be higher; however, most complications are only transient or mild, and some are even clinically silent. In addition, open surgery is still an important option.

Conclusion

For PICA trunk aneurysms, the treatment choice should be assessed on a case-by-case basis. The rate of permanent morbidity of the EVT is low. EVT is an effective method for treating PICA trunk aneurysms.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

None.

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Acknowledgements

We thank our colleagues who provided the case images.

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Author notes

  1. Kun Hou and Xianli Lv contributed equally.

Authors and Affiliations

  1. Department of Neurosurgery, First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, 130021, China

    Kun Hou, Yunbao Guo & Jinlu Yu

  2. Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China

    Xianli Lv

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Contributions

Conception and design: JY. Acquisition of data: KH, XL, and YG. Drafting of the article: KH. Critical revision of the article: JY. All authors have read and approved the final manuscript.

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Correspondence to Jinlu Yu.

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Hou, K., Lv, X., Guo, Y. et al. Endovascular treatment of posterior inferior cerebellar artery trunk aneurysm. Acta Neurol Belg 122, 1405–1417 (2022). https://doi.org/10.1007/s13760-021-01826-8

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