![]() ![]() For some patients with systemic disorders, the PICA-PICA bypass could be an optimal treatment option for proximal fusiform PICA aneurysms rather than as an alternative to the OA-PICA bypass.Īneurysm bypass surgery posterior inferior cerebellar artery. In comparison with the OA-PICA bypass, the PICA-PICA bypass is less likely to cause CSF leakage and skin complications, although it carries the risk of specific ischemic complications and requires advanced surgical techniques. The postoperative course was uneventful, and the patient was discharged on day 64 without any neurological disorders. We performed the PICA-PICA bypass and trapping surgery rather than the OA-PICA bypass to avoid skin problems and CSF leakage. The patient had many systemic disorders such as microscopic polyangiitis and steroid-induced diabetes mellitus that could have caused wound dehiscence and cerebrospinal fluid (CSF) leakage. Radiological examination revealed a right proximal PICA fusiform aneurysm. A 79-year-old man presented with a chief complaint of sudden, severe headache and disturbances in consciousness. Venous drainage recruits the medial/lateral tonsillar and retrotonsillar veins. These lesions are unilateral and primarily perfused by the ipsilateral PICA. In this article, we report a case of proximal PICA ruptured aneurysm that was treated with a PICA-to-PICA (PICA-PICA) bypass. Tonsillar AVMs are the least common of the cerebellar AVM subtypes and are localized to the caudal region of the suboccipital surface. Although a few cases of intracranial-to-intracranial bypass have been reported, this type of vascular reconstruction is only regarded as an alternative to the OA-PICA bypass because of the uncertainty of bypass feasibility and potential risk of ischemic complications. Despite its potential complications, the occipital artery-to-posterior inferior cerebellar artery (OA-PICA) bypass is a typical treatment because of its versatility. PICA aneurysm flow-diverter stent posterior circulation.Posterior inferior cerebellar artery (PICA) aneurysms often require cerebral vascular reconstruction for surgical treatment because of their characteristic morphology. The use of flow-diverter stents in the treatment of PICA aneurysms should be considered a safe and effective endovascular treatment option. Treatment of PICA aneurysms with flow-diverter stents showed positive results with a high rate of technical success and low complication and mortality rates. All of the aneurysms were completely occluded according to the latest angiographic controls (mean follow-up period of 19.5 months). 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). One patient with subarachnoid hemorrhage died because of rebleeding (modified Rankin Scale (mRS), 6). Procedural success was 100% (8/8), and there were no ischemic complications. All saccular aneurysms in the neck involved the PICA origin, and one dissecting aneurysm was localized in the proximal part of the PICA. The types of aneurysm included five aneurysms that were saccular, two that were fusiform, and one that was dissecting. The mean aneurysm diameter was 7.6 mm (range, 5 to 11 mm). 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. 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. The effectiveness and reliability of flow-diverter stents, which are commonly used in aneurysms of the anterior circulation, have been demonstrated previously. ![]()
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