gms | German Medical Science

Objective: Despite the generally well-accepted dominance of endovascular over surgical treatment for the majority of posterior circulation aneurysms, the appropriate treatment of aneurysms arising from the posterior inferior cerebellar artery (PICA) remains unclear. Therefore, we wanted to investigate the relation of clinical outcomes and treatment modality in patients undergoing surgical or endovascular repair for saccular PICA aneurysms.

Method: We performed a systematic search of the PubMed database for clinical studies reporting surgical or endovascular treatment of PICA Aneurysms using the keyword “PICA aneurysm”. The resulting abstracts and/or studies were screened for the following inclusion criteria: 1) reporting on more than 5 patients 2) reporting exclusively on treatment of saccular aneurysms 3) reported in english language. Clinical outcome was dichotomized in favorable (Glasgow outcome scale – GOS – 4 & 5) and unfavorable outcome (GOS 1–3). Treatment modality was statistically correlated with clinical outcome using Pearson correlation for nominal variables.

Results: The initital search yielded a total of 338 studies or reports. Ultimately, 14 studies reporting on 366 patients undergoing surgical or endovascular treatment for a PICA aneurysm were included in the present analysis. 280 patients were female, 88 male with an age range between 9 and 85 years. 275 patients underwent surgical and 91 patients endovascular treatment. Outcome was favorable in 283 patients (77.3%; 216 patients in the surgical group vs. 67 patients in the endovascular group) and unfavorable in 83 patients (22.7%; 59 patients in the surgical vs. 24 in endovascular group). Interestingly, the treatment modality did not correlate with clinical outcome (r=0.051, p=0.333).

Conclusions: The results of our meta-analysis are somewhat limited by inclusion of studies investigating treatment outcomes in retrospective case series as well as a strong dominance of surgical studies. Nevertheless, our results underline the current perception that in contrast to other posterior circulation aneurysms, surgical repair of PICA aneurysms remains a valid treatment option, most likely due to the less invasive surgical access.